Background: and Purpose Vertebrobasilar fusiform aneurysms (VBFAs) carry substantial morbidity and mortality, but optimal management for unruptured VBFAs remains unclear. We compared the safety and efficacy of conservative management (CM), stent-assisted coiling (SAC), and flow diverters (FDs) in patients with unruptured VBFAs, focusing on long-term prognosis. Methods: This study included data from a nationwide Chinese cohort of patients with vertebrobasilar dissecting aneurysms. Inverse probability of treatment weighting (IPTW) balanced confounders across groups. The primary outcome was poor prognosis (modified Rankin Scale score >2). Secondary outcomes included aneurysm rupture, ischemic stroke, compression symptoms, and VBFA-related deaths. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Among 1,115 patients with unruptured VBFAs, 838 (median age, 54 years; 655 men) were included. After IPTW, baseline characteristics were balanced. Median follow-up was 54 months. FD was associated with a lower risk of poor prognosis than CM (OR, 0.48 [95% CI, 0.30 to 0.77]; p=0.002), with no difference between CM and SAC. FD also reduced aneurysm rupture (OR, 0.20 [95% CI, 0.07 to 0.60]; p=0.004) and compression symptoms (OR, 0.30 [95% CI, 0.13 to 0.68]; p=0.004) versus CM. Time-to-event analyses further revealed significant differences in vertebral artery lesions and Type I–II VBFAs, whereas no significant differences were observed in basilar or vertebrobasilar junction lesions or in Type III–IV VBFAs. Conclusions Compared with CM, FD was associated with improved long-term outcomes in unruptured VBFAs, particularly in vertebral artery lesions and Type I–II VBFAs, although residual confounding cannot be excluded.

OBJECTIVE To explore the influencing factors of Shenfukang capsule in the treatment of chronic kidney disease （CKD） and construct a nomogram prediction model for evaluating its therapeutic efficacy. METHODS CKD patients who were hospitalized from July 2019 to August 2022 in the First Affiliated Hospital of Guangxi Medical University and treated with Shenfukang capsule were selected as study subjects. Clinical data of the patients were collected from the hospital’s electronic medical record system， and they were divided into an effective group and an ineffective group based on treatment outcomes. Lasso-Logistic multivariate regression analysis was used to screen the influencing factors of the efficacy of Shenfukang capsule. Using the effectiveness of Shenfukang capsule treatment as the prediction outcome and the screened influencing factors as predictor variables， a nomogram prediction model was constructed using R software. All patients were randomly divided into a training cohort and a validation cohort. The discriminative ability， calibration， and clinical net benefit of the model were evaluated using the receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis， respectively. RESULTS Lasso-Logistic regression analysis revealed that concurrent diabetes mellitus， decreased levels of blood urea nitrogen， triglycerides， and serum phosphorus， as well as prolonged prothrombin time and elevated apolipoprotein AⅠ levels， were influencing factors for reduced efficacy of Shenfukang capsule in CKD treatment. The evaluation results of the nomogram prediction model showed that the area under curve values were 0.745 and 0.797 in the training and validation cohorts， respectively， which were close and both exceeded 0.70， indicating stable predictive performance. The calibration curves demonstrated good agreement in both datasets， suggesting satisfactory calibration performance. The clinical decision curves were positioned above the two extreme reference lines， indicating high clinical benefit of the model. CONCLUSIONS Diabetes mellitus， blood urea nitrogen， triglycerides， apolipoprotein AⅠ， serum phosphorus， and prothrombin time were factors associated with the efficacy of Shenfukang capsule in CKD patients. The nomogram prediction model established in this study may provide a basis for rational clinical application of Shenfukang capsule and for improving its therapeutic efficacy in CKD.

OBJECTIVE To explore the influencing factors of Shenfukang capsule in the treatment of chronic kidney disease （CKD） and construct a nomogram prediction model for evaluating its therapeutic efficacy. METHODS CKD patients who were hospitalized from July 2019 to August 2022 in the First Affiliated Hospital of Guangxi Medical University and treated with Shenfukang capsule were selected as study subjects. Clinical data of the patients were collected from the hospital’s electronic medical record system， and they were divided into an effective group and an ineffective group based on treatment outcomes. Lasso-Logistic multivariate regression analysis was used to screen the influencing factors of the efficacy of Shenfukang capsule. Using the effectiveness of Shenfukang capsule treatment as the prediction outcome and the screened influencing factors as predictor variables， a nomogram prediction model was constructed using R software. All patients were randomly divided into a training cohort and a validation cohort. The discriminative ability， calibration， and clinical net benefit of the model were evaluated using the receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis， respectively. RESULTS Lasso-Logistic regression analysis revealed that concurrent diabetes mellitus， decreased levels of blood urea nitrogen， triglycerides， and serum phosphorus， as well as prolonged prothrombin time and elevated apolipoprotein AⅠ levels， were influencing factors for reduced efficacy of Shenfukang capsule in CKD treatment. The evaluation results of the nomogram prediction model showed that the area under curve values were 0.745 and 0.797 in the training and validation cohorts， respectively， which were close and both exceeded 0.70， indicating stable predictive performance. The calibration curves demonstrated good agreement in both datasets， suggesting satisfactory calibration performance. The clinical decision curves were positioned above the two extreme reference lines， indicating high clinical benefit of the model. CONCLUSIONS Diabetes mellitus， blood urea nitrogen， triglycerides， apolipoprotein AⅠ， serum phosphorus， and prothrombin time were factors associated with the efficacy of Shenfukang capsule in CKD patients. The nomogram prediction model established in this study may provide a basis for rational clinical application of Shenfukang capsule and for improving its therapeutic efficacy in CKD.

Objective To explore the therapeutic effect of LuoFuShan Rheumatism Plaster(LFS)on neuropathic pain(NP)and its molecular mechanism.Methods Mouse models of sciatic nerve chronic constriction injury(CCI)were treated with low,medium,and high doses(2.2,4.4,and 8.8 cm2,respectively)of LFS by topical application for 14 consecutive days.The therapeutic effects were assessed by evaluating the mechanical withdrawal threshold(MWT),paw withdrawal latency(PWL),plasma IL-6 and TNF-α levels,and histopathology of the sciatic nerve.Network pharmacology and molecular docking were used to identify the key targets and signaling pathways.The key targets were verified by RT-qPCR and immunohistochemistry.The biosafety of LFS was evaluated by measuring the organ indices and damage indicators of the heart,liver,and kidneys.Results Compared with the CCI group,LFS dose-dependently increased MWT and PWL,reduced plasma IL-6 and TNF-α levels,and alleviated sciatic nerve inflammation in the mouse models.Network pharmacology identified 378 bioactive compounds targeting 279 NP-associated genes enriched in TLR and TNF signaling.Molecular docking showed that quercetin and ursolic acid in LFS could stably bind to TLR4 and TNF-α.In the mouse models of sciatic nerve CCI,LFS significantly downregulated the mRNA expression levels of Tlr4 and Tnf-α in the spinal cord in a dose-dependent manner and lowered the protein expressions of TLR4 and TNF-α in the sciatic nerve.LFS treatment did not cause significant changes in the organ indices or damage indicators of the heart,liver and kidneys as compared with those in the CCI model group and sham-operated group.Conclusion LFS alleviates NP in mice by suppression of TLR4/TNF-α-mediated neuroinflammation with a good safety profile.

Objective:To investigate the effects of warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets on the function of autologous arteriovenous fistula (AVF) and hemodynamics in patients with uremia. Methods:A prospective study was conducted involving 90 patients with uremia who underwent AVF creation at Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People's Hospital), from January 2018 to December 2023. The patients were randomly divided into a control group (45 patients receiving aspirin enteric coated tablets) and a study group (45 patients receiving warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets). The internal diameter and blood flow of the fistula, vascular endothelial function, hemodynamics, the presence of vascular murmurs, elasticity, fistula patency and function, and the occurrence of complications were compared between the two groups. Results:After 1 month of treatment, the internal diameter of AVF increased in each group [study group: (6.69 ± 1.93) mm vs. (5.02 ± 1.56) mm; control group: (5.69 ± 1.78) mm vs. (4.93 ± 1.30) mm] compared with before treatment ( t = 8.29, 2.63, both P < 0.05). The blood flow of AVF increased in each group [study group: (530.49 ± 91.88) mL/min vs. (236.51 ± 21.84) mL/min; control group: (418.16 ± 53.87) mL/min vs. (242.36 ± 22.33) mL/min] compared with before treatment ( t = 23.85, 28.69, both P < 0.05). After 1 month of treatment, the internal diameter and blood flow of AVF in the study group were greater compared with those in the control group ( t = 2.55, 7.07, both P < 0.05). After 1 month of treatment, the levels of endothelin-1 in each group significantly decreased compared with before treatment [control group: (64.83 ± 11.80) μmol/L vs. (102.48 ± 16.60) μmol/L; study group: (49.48 ± 12.15) μmol/L vs. (104.60 ± 16.52) μmol/L] compared with before treatment ( t = -19.13, -23.51, both P < 0.05). The levels of nitric oxide [control group: (95.65 ± 14.87) ng/L vs. (78.56 ± 13.47) ng/L; study group: (86.36 ± 14.68) ng/L vs. (76.59 ± 13.56) ng/L], vascular diameter [control group: (7.20 ± 0.63) mm vs. (2.53 ± 0.50) mm; study group: (5.42 ± 0.66) mm vs. (2.47 ± 0.55) mm], vascular wall thickness [control group: (0.82 ± 0.05) mm vs. (0.28 ± 0.07) mm; study group: (0.60 ± 0.05) mm vs. (0.29 ± 0.10) mm], and blood flow [control group: (825.00 ± 65.00) mL/min vs. (314.84 ± 72.75) mL/min; study group: (623.71 ± 74.19) mL/min vs. (321.24 ± 71.62) mL/min] in each group significantly increased compared with before treatment ( t = 9.50, 4.99, 48.94, 26.89, 48.33, 22.11, 55.92, 29.50, all P < 0.05). Additionally, after 1 month of treatment, the levels of endothelin-1 in the study group were significantly lower than those in the control group ( t = 6.08, P < 0.05). The levels of nitric oxide, vascular diameter, vascular wall thickness, and blood flow in the study group were greater than those in the control group ( t = 2.98, 13.15, 21.99, 13.69, all P < 0.05). After 1 month of treatment, the shear stress of the radial artery in each group decreased significantly compared with before treatment [control group: (42.96 ± 6.54) dyne/cm2 vs. (47.62 ± 7.36) dyne/cm2; study group: (34.31 ± 6.71) dyne/cm2 vs. (46.71 ± 7.56) dyne/cm2, t = -13.30, -4.67, both P < 0.05]. The blood flow velocity at the venous end of the anastomosis significantly increased in both groups compared with pre-treatment levels [control group: (85.51 ± 8.48) cm/s vs. (74.60 ± 10.80) cm/s; study group: (119.18 ± 10.27) cm/s vs. (73.27 ± 10.37) cm/s, t = 35.92, 10.03, both P < 0.05]. The shear stress of the radial artery in the study group was lower ( t = -6.18, P < 0.05), while the blood flow velocity at the venous end of the anastomosis was higher ( t = 16.95, P < 0.05) compared with the control group. The incidence of vascular murmurs [11.11% (5/45) vs. 28.89% (13/45)] and the failure/reconstruction rate of the fistula [4.44% (2/45) vs. 24.44% (11/45)] were significantly lower compared with the control group ( Z = -2.10, -2.68, both P < 0.05). The rate of good vascular elasticity [93.33% (42/45) vs. 71.11% (32/45)] and the patency rate of the AVF [93.33% (42/45) vs. 73.33% (33/45) in the study group were significantly higher compared with the control group ( Z = 2.74, 2.53, both P < 0.05). The total incidence of complications in the study group was significantly higher than that in the control group [2.22% (1/45) vs. 20.00% (9/45), χ2 = 7.20, P < 0.05). Conclusions:Warm compresses with Jianlou Decoction combined with aspirin enteric coated tablets can increase the internal diameter and blood flow of AVF in patients with uremia, improve endothelial function and hemodynamics, reduce thrombus formation, enhance fistula function and patency rates, and decrease the incidence of fistula failure/reconstruction and complications.

Objective:To explore predictive value of quantitative evaluation of shear wave ultrasonic elastography(SWUE)on the hardness of soleus muscle for short-term progress of the distal deep venous thrombosis(DVT)of lower extremities.Methods:A total of 100 DVT patients who admitted to the second hospital of Zhangjiakou from January 2021 to December 2023 were retrospectively selected,and they were divided into group with progress(n=45)and group without progress(n=55)according to the results of the ultrasonic reexamination of blood vessels of lower extremities at the 2nd week after they were confirmed.Univariate and multivariate logistics regression analysis were used to analyze the influencing factors for short-term progress of DVT patients.Receiver operating characteristic(ROC)curve was drawn to analyze the applied value of SWUE quantitative assessment for the hardness of soleus muscle in predicting the short-term progress of DVT patients.The coagulation indicators of the two groups before and after treatment were further compared.Results:There were no significant differences between the two groups in cholesterol,neutrophil count,platelet count,central venous catheterization,bed rest,history of thrombosis,injury of vascular wall,and history of surgery for lower limb(P>0.05).The average hardness values of soleus muscle of group with progress and group without progress were respectively(6.46±1.15)kPa and(5.42±1.13)kPa,and the difference of that between two groups was significant(t=4.542,P<0.05).Multivariate logistics regression analysis showed that hardness of soleus muscle was the independent risk factor for short-term progress of DVT patients(OR=3.135,P<0.05).The results of ROC analysis showed that the area under curve(AUC)value of the hardness of soleus muscle in predicting short-term progress of DVT patients was 0.9074(95%CI:0.8175～0.9972),and the best cutoff value was 0.70,and the sensitivity and the specificity were respectively 78.26%and 91.30%at this time.Before treatment,there were no significant differences in the comparison of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and D-dimer(D-dimer)between the two groups of patients(P>0.05).After treatment,the PT,APTT and TT levels of patients in the group without progress were respectively higher than those in the group with progress,and the D-dimer level was lower than that in the group with progress,there was a statistically significant difference between the two groups(t=3.568,15.176,4.091,9.981,P<0.05),respectively.Conclusion:SWUE quantitative evaluation for the hardness of soleus muscle has a favorable predictive value for the short-term progress of distal DVT of lower extremities,which is contribute to early find the DVT short-term progress,thus can timely adopt intervention measure,and reduce the risk of complication,and improve the prognosis.

Objective To explore the differences in the use of hypoglycemic drugs and glycated hemoglobin(HbA1c)levels among elderly patients with type 2 diabetes mellitus(T2DM)of different age groups,and to provide some references for individualized blood glucose control in elderly T2DM patients.Methods A retrospective study was conducted.A total of 187 elderly(≥70 years old)T2DM patients admitted to Guangdong Provincial People's Hospital from October 2022 to August 2024 were selected as the research subjects.The patients were divided into three groups according to age:70-79(93 cases),80-89(52 cases),and≥90(42 cases)years old.The differences in glucose metabolism,lipid metabolism,renal function and the use of hypoglycemic drugs among the groups were compared.Results With increasing age,the hospital stays for the 70-79,80-89,and≥90 years old groups significantly increased(days:7.78±2.84,10.17±7.97,15.45±11.21,P<0.05),diastolic blood pressure gradually decreased[mmHg(1 mmHg≈ 0.133 kPa):75.60±9.15,73.77±10.79,67.45±9.50],estimated glomerular filtration rate(eGFR)and HbA1c both significantly decreased[eGFR(mL·min-1·1.73 m-2):65.55±23.01,49.68±20.19,46.39±16.41;HbA1c(9.02±1.99)%,(8.75±2.21)%,(7.80±1.43)%,all P<0.05].In terms of hypoglycemic treatment,the average number of hypoglycemic drugs used by the≥90 years old group was significantly less than that of the 80-89 years old group and the 70-79 years old group(types:1.86±0.78 vs.2.67±1.12,2.88±0.93,both P<0.01).With increasing age,the usage rates of sodium-glucose cotransporter 2 inhibitors(SGLT-2i)and metformin(MET)in the 70-79,80-89,and≥90 years old groups gradually decreased[SGLT-2i:50.54%(47/93),42.31%(22/52),26.19%(11/42),MET:46.24%(43/93),30.77%(16/52),7.14%(3/42),all P<0.05].Conclusions Medical workers have fully considered factors such as renal function,diabetic cardiovascular complications,health status,and life expectancy in the use of hypoglycemic drugs for elderly T2DM patients and have implemented individualized blood glucose management.However,in the≥90 years old group,the HbA1c level is too strict,and the risk of hypoglycemia should be carefully prevented.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To evaluate the role of ferroptosis in reduction of intestinal ischemia-reperfusion injury (IRI) by sodium butyrate pretreatment in mice.Methods:Thirty SPF healthy male C57BL/6 mice, aged 6-8 weeks, weighing 20-23 g, were divided into 5 groups ( n=6 each) using a random number table method: sham operation group (S group), intestinal IRI group (IR group), intestinal IRI + sodium butyrate pretreatment group (IN group), intestinal IRI + sodium butyrate pretreatment+ FER-1 group (INF group), and intestinal IRI + sodium butyrate pretreatment + Erastin group (INE group). The intestinal IRI model was established by occluding the superior mesenteric artery for 45 min followed by reperfusion for 30 min in S group. In IN, INF and INE groups, sodium butyrate was administered by gavage at a dose of 500 mg/kg daily at 1 week before developing the model, while the equal volume of normal saline was given by gavage in the other two groups. The ferroptosis inhibitor FER-1 5 mg/kg and ferroptosis agonist Erastin 30 mg/kg were intraperitoneally injected at 1 h prior to ischemia in INF and INE groups. Mice were sacrificed after anesthesia at the end of reperfusion to obtain small intestinal tissues for examination of the pathological changes (using light microscopy) which were scored according to Chiu and for determination of the contents of Fe 2+, malondialdehyde (MDA), glutathione (GSH) and glutathione disulfide(GSSG) (by enzyme-linked immunosorbent assay), expression of glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), and ferritin heavy chain 1 (FTH1) (by Western blot). The ratio of GSH to GSSG was calculated. Results:Compared to S group, Chiu′s scores and contents of MDA and Fe 2+ were significantly increased, the expression of GSH, GPX4, FTH1 and SLC7A11 was down-regulated, and the GSH/GSSG ratio was decreased in IR group ( P<0.001). Compared to IR group, Chiu′s scores and contents of MDA and Fe 2+ were significantly decreased, the expression of GSH, GPX4, FTH1 and SLC7A11 was up-regulated, and the GSH/GSSG ratio was increased in IN and INF groups ( P<0.001). Compared to IN group, Chiu′s scores and contents of MDA and Fe 2+ were significantly increased, the expression of GSH, GPX4, FTH1 and SLC7A11 was down-regulated, and the GSH/GSSG ratio was decreased in INE group ( P<0.001). Conclusions:Ferroptosis is involved in sodium butyrate pretreatment-induced reduction of intestinal I/RI in mice.

Objective:To retrospectively analyze the changes in the proportion of refined lymphocyte subsets in peripheral blood of patients with Graves disease (GD), and their correlation with the clinical characteristics and efficacy of GD, and to explore the immunological pathogenesis of Graves disease for seeking new therapeutic targets.Methods:A total of 97 newly diagnosed GD patients (GD group), 27 patients after treatment (treatment group), and 31 healthy individuals (control group) who visited the Fifth Medical Center of the PLA General Hospital from 2018 to 2021 were included in this study. The data of refined lymphocyte subsets, thyroid function, blood routine and clinical treatment of the three groups were compared and analyzed. The t-test and rank sum test were used to compare the proportions of lymphocyte subsets among different groups, and Pearson correlation analysis was used to analyze the correlation between the proportions of lymphocyte subsets and thyroid function indicators.Results:The proportion of B cells in GD group was higher than that in the control group [16.2%(11.8%, 21.8%) vs 10.2%(8.1%,13.6%)], while the proportion of natural killer (NK) cells was lower [9.4%(4.9%, 13.6%) vs 14.6%(12.1%,18.8%)], and the differences were statistically significant ( P<0.05). Abnormal T cell differentiation: the proportions of functional cells, including activated T cells, memory T cells, clustering antigen(CD)4+memory T cells, Th1 cells, and Tc1 cells, were lower than that in the control group [3.2%(2.1%, 5.7%) vs 5.8%(3.0%, 9.3%), P<0.05; 36.7% (29.9%, 48.1%) vs 48.0%(39.2%,57.7%), P<0.05; 23.1%(17.4%, 30.1%) vs 28.9%(23.3%,34.6%), P<0.05; 16.4% (11.8%, 23.6%) vs 24.3%(16.9%,28.5%), P<0.05; 28.5% (14.7%, 39.2%) vs 46.3%(21.6%,69.2%), P<0.05]. The proportion of activated T cells in the treatment group was higher than that in the GD group [6.5% (4.6%, 13.6%) vs 3.2% (2.1%, 5.7%), P<0.05]. The total triiodothyronine results showed positive correlations with B cells ( r=0.356, P<0.01) and negative correlations with NK cells ( r=?0.416, P<0.01), while the total thyroxine values showed negative correlations with NK cells and activated T cells ( r=?0.318,?0.335; P<0.01). Thyroid stimulating hormone and CD8+initial T cells were positively correlated ( r=0.382, P<0.01). The proportion of B cells, cytotoxic T cells and suppressor T cells in CD8+cells of patients with complications [such as Graves orbitopathy (GO), thyroid toxic cardiomyopathy, etc.] was significantly different from that of the simple GD patients [18.3% (14.1%, 27.1%) vs 14.6% (10.8%, 21.4%), Z=2.54, P<0.05; 73.4%(65.6%,83.6%)vs 65.0%(50.3%,79.3%), Z=2.93, P<0.05; 26.6%(16.4%, 37.5%)vs 35.0%(20.7%,49.7%), Z=?2.74, P<0.05]. The proportion of suppressor T cells in GO patients was lower than that in non-GO patients [6.1% (3.4%, 8.1%) vs 8.5% (4.9%, 13.6%), Z=?3.20 P<0.05]. Conclusion:There are significant alterations in the circulating immune cells of GD patients, suggesting that immunological abnormalities play a crucial role in the onset and progression of the disease.