Objective To investigate the effects of Mawangdui exercise combined with neuro-muscular electrical stimulation(NMES)on pulmonary function,exercise capacity and quality of life in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 96 COPD pa-tients were selected as the study subjects,and divided into control group(n=48)and intervention group(n=48).The control group received conventional pharmacological treatment,while the inter-vention group received Mawangdui exercise combined with NMES in addition to conventional pharma-cological treatment.The ratio of forced expiratory volume in the first second(FEV1)to forced vital capacity(FVC)(FEV1/FVC),the percentage of predicted FEV,(FEV1％),respiratory rate,re-sults of the 6-minute walk test(6MWT),scores of COPD Assessment Test(CAT),St.George's Respira-tory Questionnaire-I(SGRQ-I),Hospital Anxiety and Depression Scale(HADS)and Borg CR-10 Scale were analyzed in both groups before and after treatment.Results After 1 and 3 months of treatment,significant differences were observed in respiratory rate and 6MWT results between the two groups(P＜0.05).After 1 and 3 months of treatment,the FEV1％and FEV1/FVC in the intervention group were significantly higher than those at admission,and the FEV1％and FEV1/FVC after 3 months of treatment were significantly higher than those after 1 month of treatment(P＜0.05).Af-ter 3 months oftreatment,a significant difference in FEV1/FVC was observed between the two groups(P＜0.05).After 3 months of treatment,the CAT and SGRQ-I scores in the intervention group were significantly lower than those at admission(P＜0.05).After 3 months of treatment,the Borg CR-10 Scale score in the intervention group was significantly lowerthan that at admission and after 1 month of treatment(P＜0.05).After 3 months of treatment,a significant difference in SGRQ-I scores was observed between the two groups(P＜0.05).After 1 and 3 months of treatment,the HADS scores in the intervention group were significantly lower than those at admission,and the HADS score after 3 months of treatment was significantly lower than that after 1 month of treatment(P＜0.05).After 1 and 3 months of treatment,significant differences in HADS scores were ob-served between the two groups(P＜0.05).Conclusion Mawangdui exercise combined with NMES can improve exercise tolerance and pulmonary function,alleviate anxiety and depression,and thereby enhance the quality of life in COPD patients.

With the rapid advancement of refractive surgery, small incision lenticule extraction(SMILE)has become a mainstream procedure due to its biomechanical advantage in preserving the integrity of the anterior elastic layer and epithelium. However,postoperative stromal tissue removal and stress redistribution may still compromise corneal biomechanical stability, potentially affecting long-term corneal stability and visual quality. This review focuses on the mechanisms underlying biomechanical changes after SMILE, summarizing recent findings on corneal thinning, reduced mechanical strength, and stress remodeling, and their impact on corneal morphology and visual quality. It further explores potential contributors to postoperative ectasia, increased higher-order aberrations(HOAs), and visual fluctuations, highlighting individual variability and current controversies in the literature. Moreover, current evidence on adjunctive strategies such as corneal cross-linking(CXL)in enhancing biomechanical strength, reducing complications, and improving optical quality was analyzed. Finally, optimal timing for CXL, threshold values of biomechanical metrics, and the role of individualized preoperative assessment and postoperative management was discussed, aiming to provide a theoretical and clinical basis for improving safety and visual outcomes following SMILE.

Objective To explore the research trajectory and current status of regional schools of Traditional Chinese Medicine(TCM),providing scholars with a comprehensive overview of these schools to quickly understand the research context and grasp its significance and direction.Methods This analysis focuses on literature related to eight TCM schools from regions like Shanghai,Zhejiang,Anhui,Shandong,Guangdong,Heilongjiang,Sichuan,and Jiangsu,published since the establishment of New China.These schools include the Shanghai School,Zhejiang School,Xin'an School,Qilu School,Lingnan School,Longjiang School,Sichuan School,and various Jiangsu schools(such as the Wumen School,Longsha School,Menghe School,and Shanyang School).The analysis examines the development of these TCM schools from the perspective of big data and historical geography.Results The study finds that research on regional schools of TCM after the founding of the People's Republic of China is significantly influenced by the times,with the volume of literature demonstrating a phase-based trend but generally showing an overall upward trajectory.The primary publishing institutions for each school are the provincial TCM universities and their associated research institutions,playing a significant role in regional TCM studies.Current research on regional TCM schools mainly focuses on the inheritance of famous physicians' experiences,studies on historical representative physicians,data mining,and streamlining of TCM school heritage,attracting considerable attention from scholars.Currently,the best-developed research is on the Xin'an School,Zhejiang School,and Jiangsu School(including the Wumen School,Longsha School,Menghe School,and Shanyang School).Conclusion Research into the academic thoughts of representative physicians from regional TCM schools and the inheritance of famous physicians' experiences are key topics that will likely continue to attract interest for an extended period.Further in-depth analysis within these schools,and the integration of various information,are likely to be future research hotspots.

Severe intra-abdominal infections are life-threatening conditions and a significant challenge for surgeons. This article presents a case of an elderly patient with a severe intra-abdominal infection complicated by an anastomotic leak. This patient had experienced prolonged sepsis and multiple surgical traumas. Upon admission to our department, exploratory surgery revealed extensive bowel edema and adhesions, an anastomotic leak, and abdominal contamination with infection. In accordance with the principles of damage control surgery, the anastomotic leak was exteriorized, the abdomen was left open, and continuous intra-abdominal lavage with dual-lumen catheters was implemented to effectively control the infection. Negative pressure wound therapy was used to manage the open abdomen, and a negative pressure-assisted drainage device was used to manage the enteroatmospheric fistula. After granulation of the abdominal wound, split-thickness skin grafting was performed. The enteroatmospheric fistula was converted into an enterocutaneous fistula. A 3D-printed stoma baseplate was used to manage the digestive fistula. Concurrently, enhanced parenteral and enteral nutritional support was provided. Six months later, the patient successfully underwent definitive fistula resection and abdominal wall defect repair.

Objective:To evaluate the efficacy of vacuum sealing drainage (VSD) in the comprehensive management of full-thickness perineal wound dehiscence following pelvic exenteration (PE).Methods:This study employed a descriptive case series design. We retrospectively analyzed the clinical data of 29 patients who developed postoperative perineal wound infections with full-thickness dehiscence after PE. These cases included 16 patients from the Department of General Surgery at Jiangyin People's Hospital (Jiangsu Province) and 13 patients from the Department of Colorectal Surgery at the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital). VSD was applied to manage the dehisced wounds, with outcomes assessed based on wound healing time, complications, and follow-up data.Results:A total of 29 patients were included in the study. The operative time for PE was (498 ± 83) minutes. Among them, 23 patients underwent combined sacrococcygeal resection. The median number of VSD devices used was 28 (22, 39). The postoperative perineal wound healing time was 95 (82, 110) days in patients who underwent combined sacrococcygeal resection, 74 (63, 89) days in those without sacrococcygeal resection, 93 (79, 102) days in those treated with simple pelvic-abdominal isolation using a biological basement membrane mesh and 76 (60, 91) days in those who received combined pelvic packing with a pedicled omental flap. All patients uniformly developed Clavien-Dindo grade III complications at 2 weeks postoperatively, manifesting as perineal wound infection and dehiscence, which were successfully managed with VSD therapy. Subsequent evaluation identified delayed (>30 days) grade III complications, including enterocutaneous (3 cases) and urinary (2 cases) fistulae, all requiring surgical revision. All patients completed the follow-up at 6 months postoperatively. Three patients still presented with minimal exudate from the perineal wound, which resolved after standardized wound care and packing with alginate silver ion dressings. Four cases (13.8%) developed stoma high-output syndrome, which improved after oral medication. Eight patients (27.6%) developed adhesive intestinal obstruction, which improved with conservative treatment.Conclusions:VSD demonstrates unique advantages in managing complex wounds. For full-thickness perineal wound dehiscence after PE, VSD is a safe and effective therapeutic strategy.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To evaluate the predictive value of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio(TAPSE/sPAP) in identifying precapillary pulmonary hypertension(pcPH) patients requiring repeat balloon pulmonary angioplasty(BPA) within 3 months after initial intervention, and to determine independent risk factors associated with postoperative reintervention.Methods:We retrospectively collected clinical data from 215 consecutive patients with pcPH undergoing BPA. After applying exclusion criteria, 200 patients were ultimately included in the analysis. The predictive value of the TAPSE/sPAP for short-term BPA reintervention was assessed using receiver operating characteristic( ROC) curve analysis and multivariable logistic regression. Internal validation was performed through bootstrap resampling with 1 000 iterations to evaluate model stability. Results:A risk model for echocardiography was constructed using multiple logistic regression, and the results showed that systolic pulmonary artery pressure(sPAP), peak tricuspid regurgitation velocity(TRV), tricuspid regurgitation pressure gradient(PGTR), and TAPSE/sPAP ratio were predictive factors for BPA surgery in patients with pulmonary hypertension within 3 months. Multivariate regression analysis suggests that the TAPSE/sPAP ratio is an independent influencing factor for BPA after 3 months( OR=0.023, P<0.05). The predicted area under the ROC curve( AUC) for BPA after 3 months is 0.62(95% CI: 0.530-0.648), P<0.01, which is better than other cardiac ultrasound indicators. At the same time, internal bootstrap method was used for internal self-validation, and the AUC of the internal self-validation set was 0.67. Conclusion:The TAPSE/sPAP ratio serves as an independent predictor for requiring repeat BPA within 3 months postoperatively in patients with pcPH.

Objective:To investigate the clinical efficacy of minimally invasive percutaneous internal fixation with double screws for delayed union or nonunion of scaphoid fracture.Methods:A retrospective study was conducted to analyze the 12 patients with delayed union or nonunion of scaphoid fracture who had been treated at Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University from March 2021 to December 2023. They were 11 males and 1 female, with an age of (29.9±13.8) years and an interval from injury to surgery of (5.1±2.6) months. They were all treated by minimally invasive percutaneous internal fixation with 2 hollow compression screws. The visual analogue scale (VAS), grip strength (percentage of the affected side to the healthy side), wrist range of motion, modified Mayo wrist score and other data were recorded and compared between pre-surgery and the last follow-up. The incidence of complications was recorded.Results:Follow-up for all patients lasted for (20.8±8.9) months. All patients achieved bony union after (10.1±3.2) weeks with no complications like infection. No post-surgery imaging revealed screw misplacement or penetration. At the last follow-up, the VAS pain score was 0 (0, 1) point, the wrist grip strength 100.6%±7.2%, the wrist flexion 88.3°±2.5°, the wrist dorsiflexion 88.5°±2.2°, and the modified Mayo wrist score (98.3±2.5) points, all significantly better than the pre-surgery values [4 (4, 5) points, 69.1%±16.0%, 61.3°±13.5°, 64.7°±9.1°, and (61.7±10.1) points] (all P < 0.05). Conclusion:In the treatment of delayed union or nonunion of scaphoid fracture, minimally invasive percutaneous internal fixation with double screws shows advantages of minimal invasion, quick fracture healing, fine functional recovery, and no need of bone grafting.