To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Objective:To observe the long-term effect of superficial temporal fascia flap combined with severed auricle reimplantation in emergency repair of partial auricle of complete separation.Methods:The data of patients with partial auricle of complete separation admitted to Emergency Clinic of Burn and Plastic Surgery of General Hospital of Northern Theater Command from June 2014 to August 2023 were retrospectively analyzed. All of them were repaired with a superficial temporal fascia flap combined with amputating auricle reimplantation. During the operation, the superficial temporal fascia flap was harvested, and the pedicle was preserved. Then the detached auricular cartilage was removed and used as a replantation scaffold. Then the remaining skin was thinned to create a full-thickness skin graft after cartilage detachment. Referring to the position and angle of the contralateral auricle, the cartilage scaffold was sutured and fixed at the stump of the ear cartilage. The wound was covered with a superficial temporal fascia flap and a full-thickness skin graft, and then packed and sutured. The postoperative observation indicators mainly confirm whether the surgery was successful, the healing condition of the replanted ear, and whether there were problems such as skin flap necrosis, infection, hematoma, etc. The shape, color, texture and tactile recovery of the reconstructed auricle were evaluated by long-term follow-up for more than 1 year. The Vancouver scar scale (VSS) was used to assess scarring in both donor and recipient sites (total score of 0-15 points, higher scores indicated more severe scarring). The Likert 5-level scoring method was used to evaluate the patients’ satisfaction with the surgical results (total score of 30 points, ≥27 points were very satisfied, 24-26 points were somewhat satisfied, 18-23 points were indifferent, 15-17 points were somewhat dissatisfied, ≤14 points were very dissatisfied).Results:A total of 8 patients were enrolled, including 5 males and 3 females. Their ages ranged from 26 to 65 years, with an average of 41 years. All patients had unilateral ear defects, with 3 cases in the left ear and 5 cases in the right ear. The defect areas ranged from 1.5 cm × 2.5 cm to 5.0 cm × 4.0 cm. During the surgery, the harvested superficial temporoparietal fascia flaps ranged from 4.5 cm × 6.5 cm to 15.0 cm × 10.0 cm. After surgery, both the flaps and full-thickness skin graft healed satisfactorily, with primary healing observed in both the donor and recipient sites. There were no complications such as necrosis, infection, or hematoma were observed. The follow-up period ranged from 3 to 9 years, with an average of approximately 6.3 years. Except for one case that required a defatted surgery at the second stage, the reconstructed auricles of the remaining patients were basically consistent with the healthy side, with smooth contour lines, skin color and texture close to the surrounding tissues, and improved tactile sensitivity. In the final follow-up, the VSS scores for both the donor and recipient sites were ≤3 for all patients. All patients rated the surgical outcome as very satisfied.Conclusion:For the partial auricle of complete separation that has no chance of replantation, the use of superficial temporal fascia flap and detached ear composite graft to repair is a reliable and effective surgical method. Patients have good postoperative long-term effects and high levels of satisfaction.

Objective:To observe the long-term effect of superficial temporal fascia flap combined with severed auricle reimplantation in emergency repair of partial auricle of complete separation.Methods:The data of patients with partial auricle of complete separation admitted to Emergency Clinic of Burn and Plastic Surgery of General Hospital of Northern Theater Command from June 2014 to August 2023 were retrospectively analyzed. All of them were repaired with a superficial temporal fascia flap combined with amputating auricle reimplantation. During the operation, the superficial temporal fascia flap was harvested, and the pedicle was preserved. Then the detached auricular cartilage was removed and used as a replantation scaffold. Then the remaining skin was thinned to create a full-thickness skin graft after cartilage detachment. Referring to the position and angle of the contralateral auricle, the cartilage scaffold was sutured and fixed at the stump of the ear cartilage. The wound was covered with a superficial temporal fascia flap and a full-thickness skin graft, and then packed and sutured. The postoperative observation indicators mainly confirm whether the surgery was successful, the healing condition of the replanted ear, and whether there were problems such as skin flap necrosis, infection, hematoma, etc. The shape, color, texture and tactile recovery of the reconstructed auricle were evaluated by long-term follow-up for more than 1 year. The Vancouver scar scale (VSS) was used to assess scarring in both donor and recipient sites (total score of 0-15 points, higher scores indicated more severe scarring). The Likert 5-level scoring method was used to evaluate the patients’ satisfaction with the surgical results (total score of 30 points, ≥27 points were very satisfied, 24-26 points were somewhat satisfied, 18-23 points were indifferent, 15-17 points were somewhat dissatisfied, ≤14 points were very dissatisfied).Results:A total of 8 patients were enrolled, including 5 males and 3 females. Their ages ranged from 26 to 65 years, with an average of 41 years. All patients had unilateral ear defects, with 3 cases in the left ear and 5 cases in the right ear. The defect areas ranged from 1.5 cm × 2.5 cm to 5.0 cm × 4.0 cm. During the surgery, the harvested superficial temporoparietal fascia flaps ranged from 4.5 cm × 6.5 cm to 15.0 cm × 10.0 cm. After surgery, both the flaps and full-thickness skin graft healed satisfactorily, with primary healing observed in both the donor and recipient sites. There were no complications such as necrosis, infection, or hematoma were observed. The follow-up period ranged from 3 to 9 years, with an average of approximately 6.3 years. Except for one case that required a defatted surgery at the second stage, the reconstructed auricles of the remaining patients were basically consistent with the healthy side, with smooth contour lines, skin color and texture close to the surrounding tissues, and improved tactile sensitivity. In the final follow-up, the VSS scores for both the donor and recipient sites were ≤3 for all patients. All patients rated the surgical outcome as very satisfied.Conclusion:For the partial auricle of complete separation that has no chance of replantation, the use of superficial temporal fascia flap and detached ear composite graft to repair is a reliable and effective surgical method. Patients have good postoperative long-term effects and high levels of satisfaction.

Anticoagulants are the cornerstone of the prevention and treatment of thromboembolic diseases. Existing parenteral and oral anticoagulants achieve effective control of thrombosis by interfering with key aspects of the coagulation cascade reaction， but this is accompanied by an increased risk of bleeding. FⅪ inhibitors， anticoagulants targeting coagulation factor Ⅺ （FⅪ）， can block the amplification phase of the thrombin generation process by inhibiting FⅪ， reducing thrombogenesis with less impact on normal hemostatic effects， and have become one of the most promising new anticoagulants. There are currently no marketed FⅪ inhibitor drugs， while FⅪ inhibitors in phase Ⅱ or phase Ⅲ clinical trials include 3 classes：antisense oligonucleotide， monoclonal antibody and small molecule inhibitors. In addition， most of the natural inhibitors and nucleic acid aptamers targeting FⅪ are under preclinical development. As new target drugs for anticoagulation therapy， FⅪ inhibitors are expected to become a safer and more effective therapeutic option， compensating for the limitations of current anticoagulants and providing patients with more effective thromboprophylaxis and therapeutic options while reducing the risk of bleeding.

Cystic echinococcosis, a zoonotic disease that poses a significant threat to human health and animal husbandry development, is prevalent across the world and predominantly occurs in agricultural and pastoral regions. However, cystic echinococcosis cases are rare in non-endemic areas, which is likely to cause misdiagnosis or missing diagnosis, resulting in delay in treatment. This report presents an overseas imported cystic echinococcosis case misdiagnosed as pulmonary and hepatic cysts, so as to provide insights into diagnosis and treatment of cystic echinococcosis in non-endemic areas.

To research and design a new type of distal radial artery puncture compression hemostatic device,to solve the problem of distal radial artery puncture and compression hemostat that has not been clinically applied in China.The hemostatic device was mainly composed of hemostatic part,pressure regulating part,fixing part and visual window.The hemostatic device can accurately compress the puncture point,and it was convenient for medical staff to observe the wound through the visual window,find out abnormal conditions such as bleeding or hematoma in time,and take measures to deal with them,which greatly improved the hemostatic effect and comfort of the postoperative puncture point.The new hemostatic device has the advantages of reasonable design and simple clinical operation,which is worthy of clinical promotion.

Peripheral neuropathies are commonly diagnosed in different clinical department of the hospital. The diagnosis is generated by a set of reasonable process based on the manifestations of patients. According to the age of onset, the speed of disease development and the symptoms of peripheral nerve lesions, the peripheral neuropathy is divided into a definite clinical subtype for a particular patient. On this basis, utility of the nerve conduction studies and electromyography is conducted to confirm the anatomical locations of peripheral neuropathy. The etiologic diagnosis is based on anatomical diagnosis of peripheral nerve with a reasonable choice of auxiliary tests, including serological testing, peripheral nerve imaging and biopsy. Genetic tests are chosen for patients with clinical suspective diagnosis of hereditary disease. Finally, therapy evaluation on the basis of etiologic diagnosis is important for forming a treatment plan.

ObjectiveTo investigate the trends in diabetes mortality rate and the characteristics of decreased population in Fengxian District, Shanghai from 2012 to 2021. MethodsData from the death registration records of the residents in Fengxian District between 2012 and 2021, sourced from the Shanghai Death Surveillance System, were analyzed. Indicators such as the crude mortality rate due to diabetes, the standardized mortality rate, years of life lost (YLL), and the probability of premature death were estimated. Annual percentage change (APC) was used to analyze the temporal trends of mortality and the probability of premature death due to diabetes. Rate decomposition analysis was used to assess the contributions of demographic and non-demographic factors to diabetes mortality. ResultsFrom 2012 to 2021, there were 1 471 deaths due to diabetes in Fengxian District, with a crude mortality rate of 27.51/100 000 and a standardized mortality rate of 17.58/100 000. The crude mortality rate showed an overall increasing trend (APC=4.58%, Z=3.49, P<0.05). The potential years of life lost (PYLL) due to diabetes over this period amounted to 9 715 person-years, with a PYLL rate of 1.82 ‰, and the average years of life lost (AYLL) was 11.94 years. The probability of premature death was 0.41% (APC=3.36%, t=2.33, P<0.05). Both population aging and non-aging factors contributed to the increase in diabetes mortality, with overall contribution rates of 67.99% and 32.01%, respectively. Among men, the contribution rates were 60.57% and 39.43%, while among women, they were 79.43% and 20.57%, respectively. ConclusionFrom 2012 to 2021, both the crude mortality rate and the probability of premature death due to diabetes showed an upward trend among the residents in Fengxian District, with a higher YLL. Population aging was the main factor causing the increase in mortality rate, while non-demographic factors had a greater impact on the rise in diabetes mortality among men than that in women. Therefore, the management on male diabetes patients should be strengthened.

AIM:To observe the efficacy and safe-ty of combined lipid-lowering strategies in the ini-tial stage of treatment in"very high-risk ASCVD"pa-tients in cardiology outpatient clinics in a real-world prospective cohort study.METHODS:Pa-tients with"very high-risk ASCVD"from January to June 2021 were consecutively enrolled and divided into three groups according to the actual lipid-low-ering treatment strategies:Atorvastatin group;Atorvastatin combine with ezetimibe group;Atorv-astatin combine with evolocumab group.The pri-mary observation endpoints were the changes in LDL-C,Lp(a),and non-HDL-C after one month of treatment,and the secondary endpoints were the changes in TC,TG,HDL-C,Hs-CRP,and safety indica-tors.RESULTS:The efficacy of the combined lipid-lowering strategy in the initial stage of treatment was significantly better than that of the Atorvas-tatin group:LDL-C,Log[Lp(a)],non-HDL-C,TC sig-nificantly decreased(all P＜0.05).Compared with the Atorvastatin combine with Ezetimibe group,LDL-C and Log[Lp(a)]decreased significantly in the Atorvastatin combine with Evolocumab group(P＜0.05),and TC and TG had decreased insignifi-cantly(P＞0.05).When"LDL-C＜1.4mmol/L or＜1.8 mmol/L"is used as the standard for lipid-low-ering compliance,the LDL-C compliance rates of the two groups of combined lipid-lowering treat-ments are higher than those of the atorvastatin sin-gle-drug group.The differences were all statistically significant(all P＜0.05);the LDL-C compliance rate of the atorvastatin combined with evolocumab group was higher than that of the atorvastatin com-bined with ezetimibe group,and the differences were statistically significant(All P＜0.05).When the reduction rate of"LDL dropped by more than 50％"alone or in combination were used as the standard,no one in the three groups could reach the stan-dard.The liver aminotransferase levels had no signif-icant changes among the 3 groups after treatment(all P＞0.05).Myocardial enzyme isoenzyme(CK-MB)decreased among the 3 groups insignificantly(P＞0.05).Compared with the Atorvastatin group,the blood sugar(BS)of the two combined lipid-low-ering groups decreased significantly(P＜0.05);The BS of the Atorvastatin+ezetimibe group significant-ly decreased than that of Atorvastatin combine with Evolocumab group(P＜0.05).CONCLUSION:The lipid-lowering effect and LDL-C compliance rate of patients with"very high-risk ASCVD"in the cardi-ology outpatient department after 1 month of com-bined lipid-lowering treatment were better than those of the atorvastatin monotherapy group.When LDL-C＜1.4 mmol/L or＜1.8 mmol/L is the lip-id-lowering target,the LDL-C compliance rate after 1 month of treatment in the atorvastatin combined with evolocumab group is higher than that of the combined atorvastatin and zetamibu group.When the"LDL drop by more than 50％"is used as the standard for lipid lowering,it is difficult to reach the standard within 1 month.Outpatient"very high-risk ASCVD"patients were treated with initial combined lipid-lowering therapy for 1 month with-out adverse reactions.The initial combined lipid-lowering strategy can be used for patients with"very high-risk ASCVD"in cardiology outpatient clinics who need to achieve LDL-C values early.Atorvastatin combined with evolocumab strategy can be recommended for those patients who re-quire LDL-C＜1.4 mmol/L or＜1.8 mmol/L within one month.