Objective: To determine the clinical efficacy and mechanism of Piwei Peiyuan Pill (PPP) combined with moxibustion for treating patients with chronic atrophic gastritis (CAG) with spleen and stomach weakness syndrome. Methods: Ninety-six CAG patients with spleen and stomach weakness syndrome who met the inclusion and exclusion criteria were enrolled at the Department of Spleen and Stomach Diseases of the Second Affiliated Hospital of Anhui University of Chinese Medicine from June 2022 to December 2023. The patients were randomly divided into a control, a Chinese medicine, and a combined group using a random number table method, with 32 cases in each group (two cases per group were excluded). The control group was treated with rabeprazole combined with folic acid tablets (both thrice daily), the Chinese medicine group was treated with PPP (8 g, thrice daily), and the combined group was treated with moxa stick moxibustion (once daily) on the basis of the Chinese medicine group for 12 consecutive weeks. Gastric mucosa atrophy in the three groups was observed before and after treatment. The gastric mucosal pathological score was evaluated. The Patient Reported Outcome (PRO) scale was used to evaluate the patients′ physical and mental health status and quality of life.An enzyme-linked immunosorbent assay was used to detect serum tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-4, IL-10, IL-37, and transforming growth factor (TGF)-β levels in each group. Real-time fluorescence PCR was used to detect the relative expression levels of signal transducer and activator of transcription 3 (STAT3) and mammalian target of rapamycin (mTOR) mRNA in each group. Western blotting was used to detect the relative expression levels of proteins related to the STAT3/mTOR signaling pathway, and the adverse drug reactions and events were recorded and compared. Results: There was no statistical difference in age, gender, disease duration, family history of gastrointestinal tumors, alcohol consumption history, and body mass index among the three groups of patients.The total therapeutic efficacy rates of the control, Chinese medicine, and combined groups in treating gastric mucosal atrophy were 66.67% (20/30), 86.67% (26/30), and 90.00% (27/30), respectively (P<0.05). Compared to before treatment, the pathological and PRO scale scores of gastric mucosa in each group decreased after treatment, and TNF-α, IL-1β, IL-37, and TGF-β levels decreased. The relative STAT3 and mTOR mRNA expression levels, as well as the relative STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels decreased (P<0.05), whereas the IL-4 and IL-10 levels increased (P<0.05). After treatment, compared to the control group, the pathological score of gastric mucosa, PRO scale score, TNF-α, IL-1β, IL-37, TGF-β content, relative STAT3 and mTOR mRNA expression levels, and relative STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels in the Chinese medicine and combined groups after treatment were reduced (P<0.05), whereas the IL-4 and IL-10 levels increased (P<0.05). After treatment, compared to the Chinese medicine group, the combined group showed a decrease in relative STAT3, mTOR mRNA expression levels, and STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels (P<0.05). Conclusion The combination of PPP and moxibustion may regulate the inflammatory mechanism of the body by inhibiting the abnormal activation of the STAT3/mTOR signaling pathway, upregulating related anti-inflammatory factor levels, downregulating pro-inflammatory factor expression, and increasing related repair factor expression, thereby promoting the recovery of atrophic gastric mucosa, reducing discomfort symptoms, and improving the physical and mental state of CAG patients with spleen and stomach weakness syndrome.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective To study the expression levels and clinical significance of histone H3 trimethylation at lysine 4(H3K4me3),histone H3 trimethylation at lysine 27(H3K27me3)and modifying enzyme in placental tissue of patients with premature rupture of membranes(PROM)with chorioamnionitis.Methods Clinical data of 95 pregnant women treated in the Xi'an Gaoxin Hospital due to PROM from June 2021 to December 2023 were retrospectively collected,and they were divided into infected group and a non-infected group according to whether they were complicated with histological chorioamnionitis(HCA).Another 30 normal pregnant women were selected as the control group.Placental tissues of all subjects were collected and H3K4me3 and H3K27me3 levels were detected,and the expression levels of H3K4me3,H3K27me3 specific methyltransferase[mixed lineage leukemia protein-1(MLL1),Zeste enhancer homolog 2(EZH2)]and demethyltransferase[lysine-specific demethylase 5B(KDM5B),Jumonji domain-containing protein 3(JMJD3)]were detected by quantitative real-time PCR(qRT-PCR).The expression differences of H3K4me3,H3K27me3 and specific modifiers among the three groups and the correlation with the histological stage of HCA were analyzed.The Receiver operating characteristic curve(ROC)was plotted,the Area under curve(AUC)value was calculated,and H3K4me3 was evaluated.Predictive value of H3K27me3 for concurrent HCA infection.Result Compared with the control group,the levels of H3K4me3(0.08%±0.02%,0.12%±0.03%vs 0.25%±0.06%),MLL1 mRNA(1.32±0.16,1.44±0.23 vs 2.02±0.31),and JMJD3 mRNA(0.78±0.13,0.91±0.15 vs 1.53±0.23)in the infected and non-infected groups were significantly decreased(t=10.939～19.062),while the levels of H3K27me39(0.23%±0.05%,0.15%±0.03%vs 0.10%±0.02%),EZH2 mRNA(1.96±0.26,1.85±0.25 vs 1.15±0.29)and KDM5B(1.46±0.15,1.35±0.18 vs 0.94±0.12)were significantly increased(t=6.077～14.974),and the levels in the infected group were lower/higher than those in the non-infected group(t=2.017～10.688),with statistically significant differences(all P<0.05).There was a significant negatively correlation between H3K4me3 and H3K27me3 levels in placenta tissue of PROM(r=-0.604,P<0.05).The levels of H3K4me3,MLL1 and JMJD3 were negatively correlated with the histological stages of HCA(r=-0.646,-0.489,-0.503,all P<0.05).The levels of H3K27me3,EZH2 and KDM5B were positively correlated with the histological stages of HCA(r=0.632,0.515,0.520,all P<0.05).The cutoffvalues of H3K4me3 and H3K27me3 were 0.10%and 0.19%,respectively.The AUC(95%CI)value of the combined prediction of PROM combined with HCA infection was 0.896(0.882～0.947),and the sensitivity and specificity were 92.14%and 86.23%respectively,which was significantly higher than the diagnosis of a single index.Conclusion The levels of H3K4me3,H3K27me3 and modifying enzymes in the placenta tissue of PROM are closely related to HCA infection and histological stage,which has high clinical prediction value for HCA infection and is expected to be a new biomarker for clinical diagnosis.

Objective:Micro-and nanostructures with sharp disordered and rounded ordered features were fabricated on titanium surfaces,respectively,and their osteogenic potential was evaluated both in vitro and in vivo.Methods:Sharp disordered titanium surfaces(SLA-Ti)and rounded ordered titanium surfaces(Laser-Ti)were prepared using sandblast acid etching and high-repeti-tion-rate femtosecond laser,respectively.Smooth titanium(Ti)was used as the control group,SLA-Ti and Laser-Ti were used as the experimental groups.Characterization was conducted using scanning electron microscopy coupled with hydrophilicity assess-ments.The adhesion,elongation,and osteogenic differentiation capabilities of osteoblasts in vitro were evaluated through cell mor-phology observations,cytoskeletal fluorescence staining,cell viability assays,and PCR experiments.Osteogenic potential in vivo of rabbits was assessed through Micro CT scans and histological staining(HE and Masson).Results:The surface of Laser-Ti exhibits a rounded,ordered,multi-scale micro-and nano-morphology with the best hydrophilicity(P＜0.01).In vitro,it promotes cell adhe-sion,extension,and osteogenic differentiation,while in vivo,it enhances bone regeneration around the implants.Overall,a trend of Laser-Ti＞SLA-Ti＞Ti is observed,with a higher bone volume fraction(BV/TV)(P＜0.05),greater trabecular thickness(Tb.Th)(P＜0.05),an increased number of trabeculae(Tb.N)(P＜0.05),and a larger area of bone around the implants(P＜0.05).Conclusion:The rounded ordered micro-and nano-structures fabricated using high-repetition-rate fem-tosecond laser demonstrate enhanced osteoinductive capac-ity both in vitro and in vivo.

Objective To analyze the occurrence and risk factors of needlestick and sharps injuries(NSIs)among oral health care workers(HCWs).Methods NSIs reported by West China Hospital of Stomatology from 2020 to 2023 were collected,and factors relevant to NSIs were analyzed.Results A total of 391 cases of NSIs were repor-ted.Only one case of injury was caused by a sterile device,while the remaining 390 cases were caused by contamina-ted devices.There were 85,107,113,and 86 cases in 2020,2021,2022,and 2023,respectively.Most NSIs oc-curred among interns(n=235,60.1％).294 cases(75.2％)of NSIs occurred among HCWs who had less than 3 years of clinical experience.The distribution of NSIs among 235 interns in different months showed that NSIs ac-counted for a relatively high proportion from April to June and July to September,and the difference was statistica-lly significant(P＜0.05).The ventral side of the left thumb was the most common site of NSIs(n=53,13.6％),followed by the ventral side of the right index finger(n=45,11.5％)and the ventral side of the left index finger(n=44,11.3％).The most common devices involved in NSIs were various types of syringe needles(n=84,21.5％),followed by various types of dental burs(n=76,19.4％)and suture needles(n=49,12.5％).Injuries mainly oc-curred during the treatment process(n=212,54.2％)and in the department of endodontics(n=86,22.0％).This study didn't find any occupational bloodborne infection case caused by NSIs.Conclusion NSIs mainly occur among inexperienced oral interns,and devices causing NSIs are related to the treatment process.

Objective:To establish graded forecast models of pollen concentration in spring and summer-autumn in northern China, based on long-term data of pollen and allergic rhinitis (AR) medical visits in 8 cities of northern China.Methods:Pollen concentration and the characteristics of AR patients from 8 cities of northern China, including Beijing, Baotou, Hohhot, Xi′an, Xining, Cangzhou, Liaocheng and Zibo, were analyzed. Spearman′s correlation was used to examine the relationship between pollen concentration and daily AR patient visits. A pollen concentration grading was establish, and a pollen forecast model was created using the eXtreme gradient boosting (XGBoost) algorithm. The model incorporated meteorological factors and the 3-day moving average of pollen concentrations.Results:The spring pollen period started early and lasted long in Beijing and Xi ′an, while the summer-autumn pollen period started earlier and persisted longer in Xining, Baotou and Hohhot. During summer-autumn pollen period, and the spring period in most cities (except Baotou and Cangzhou), average daily patient visits were significantly higher than those in non-pollen periods. A strong correlation was observed between daily AR patient visits and the 3-day moving average of pollen concentrations in both the spring and summer-autumn periods across all cities. Based on the correlation, a pollen concentration grading standard of northern China was established. The accuracy evaluation of pollen concentration prediction model showed that the percentage of forecasts with either completely accurate or within one level difference exceeded 91% in spring and 95% in summer-autumn. The most important predictive variable in the model was the pollen level from previous day, followed by the temperature and humidity.Conclusion:The grading prediction model for pollen concentration provides guidance for AR patients in term of travel, early defense and treatment, as well as the determining medication schedules for clinical drug research and specific immunotherapy.

Acute respiratory distress syndrome(ARDS)is a common respiratory emergency,but current clinical treatment remains at the level of symptomatic support and there is a lack of effective targeted treatment measures.Our previous study confirmed that inhalation of hydrogen gas can reduce the acute lung injury of ARDS,but the application of hydrogen has flammable and explosive safety concerns.Drinking hydrogen-rich liquid or inhaling hydrogen gas has been shown to play an important role in scavenging reactive oxygen species and maintaining mitochondrial quality control balance,thus improving ARDS in patients and animal models.Coral calcium hydrogenation(CCH)is a new solid molecular hydrogen carrier prepared from coral calcium(CC).Whether and how CCH affects acute lung injury in ARDS re-mains unstudied.In this study,we observed the therapeutic effect of CCH on lipopolysaccharide(LPS)induced acute lung injury in ARDS mice.The survival rate of mice treated with CCH and hydrogen inhalation was found to be comparable,demonstrating a significant improvement compared to the untreated ARDS model group.CCH treatment significantly reduced pulmonary hemorrhage and edema,and improved pulmonary function and local microcirculation in ARDS mice.CCH promoted mitochon-drial peripheral division in the early course of ARDS by activating mitochondrial thioredoxin 2(Trx2),improved lung mitochondrial dysfunction induced by LPS,and reduced oxidative stress damage.The results indicate that CCH is a highly efficient hydrogen-rich agent that can attenuate acute lung injury of ARDS by improving the mitochondrial function through Trx2 activation.

Objective To investigate the inhibitory effect of Zheng Gan Decoction(ZGF)on tumor progression in a rat model of diethylnitrosamine(DEN)-induced hepatocellular carcinoma(HCC)and explore the possible mechanism.Methods Seventy SD rats were subjected to regular intraperitoneal injections of DEN(50 mg/kg)for 12 weeks to induce HCC tumorigenesis,with another 10 rats receiving saline injections as the normal control.After successful modeling,the rats were randomized into 5 groups(n=10)for daily treatment with distilled water(model group),Huaier Granules(4 g/kg;positive control group),or ZGF at low,medium,and high doses(2,4,and 8 g/kg,respectively)via gavage for 17 weeks.Body weight changes of the rats were monitored,and after completion of the treatments,the rats were euthanized for measurement of liver,spleen and thymus indices and morphological and histopathological examinations of the liver tissues using HE staining.The expressions of YAP,p-YAP,MST1,LATS1 and p-LATS1 in the liver tissues were detected using immunohistochemistry and Western blotting.Results Compared with the normal control rats,the rat models with DEN-induced HCC exhibited much poorer general condition with a significantly reduced survival rate,increased body weight and liver and spleen indices,and a lowered thymus index.ZGF treatment obviously reduced liver and spleen indices,increased the thymus index,and improved pathologies of the liver tissues of the rat models.Immunohistochemistry and Western blotting showed a dose-dependent reduction of YAP expression and an increment of p-YAP expression in ZGF-treated rats,which also exhibited significantly upregulated hepatic expressions of MST1,LATS1 and p-LATS1.Conclusion ZGF inhibits DEN-induced HCC in rats by activating the Hippo/YAP pathway via upregulating MST1 and LATS1 expression,which promotes YAP phosphorylation and degradation to suppress proliferation and induce apoptosis of the tumor cells.

Objective:To explore the effect of immobility on the quality of life in older adults.Methods:This cross-sectional study included 244 consecutive elderly patients aged 60 years and older who were admitted to the Department of Geriatrics at Xuanwu Hospital of Capital Medical University from May 2022 to March 2023.Among the participants, 52.5%(128/244)were male and 47.5%(116/244)were female, with a mean age of 69.2±7.4 years.All participants underwent a series of assessments, including the Short Physical Performance Battery(SPPB), grip strength measurement, gait speed evaluation, and the Timed Up and Go test(TUG).The Barthel Index was employed to assess activities of daily living, while the Medical Outcomes Study 36-Item Short Form Health Survey(SF-36)was used to evaluate quality of life.A score of SPPB ≤ 9 was used to diagnose immobility.Results:A total of 60 older adults met the criteria for immobility.Compared to the non-immobility group, the quality-of-life scores for older adults in the immobility group were significantly lower across various dimensions, including physical functioning, role-physical, bodily pain, general health, vitality, social functioning, physical component summary, and the total SF-36 score(all P<0.05).Furthermore, a positive correlation was identified between the SPPB scores and the quality-of-life scores across the dimensions of physical functioning, bodily pain, general health, vitality, social functioning, mental health, reported health transition, physical component summary, and the total SF-36 score among patients in the immobility group(all P<0.05).Additionally, older adults in the immobility group exhibited lower grip strength, slower gait speed, and longer TUG times, as well as a higher incidence of emergencies and falls over the past year(all P<0.05). Conclusions:The poorer quality of life and physical function, along with higher rates of emergencies and falls among older adults with immobility, indicate the necessity of addressing the health consequences that immobility inflicts on this population.