ObjectiveTo investigate the mechanism by which modified Shengjiangsan （MSJS） improves diabetic kidney disease （DKD） by activating mitochondrial autophagy. MethodsSixty SPF-grade male Sprague-Dawley rats aged 7-8 weeks were selected. A DKD model was established using a high-sugar， high-fat diet combined with intraperitoneal injection of streptozotocin （STZ）. After successful modeling， the rats were randomly divided into six groups： a normal control group， a model group， low-， medium-， and high-dose MSJS groups （7.7， 15.4， 30.8 g·kg^-1， respectively）， and an irbesartan group （0.384 g·kg^-1）. Each group received either normal saline or the corresponding drug by gavage once daily for 28 consecutive days. Blood glucose， body weight， and kidney weight were recorded. Serum creatinine （SCr） and blood urea nitrogen （BUN） levels were detected using an automatic blood analyzer. Enzyme-linked immunosorbent assay （ELISA） was used to determine urinary microalbumin （mALB）， and serum levels of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-6 （IL-6）. Histopathological changes in renal tissues were observed using hematoxylin-eosin （HE） staining， periodic acid-Schiff （PAS） staining， and transmission electron microscopy （TEM）. The expression levels of mitochondrial autophagy-related proteins in renal tissues were analyzed by Western blot. Immunofluorescence co-localization was employed to detect the co-expression of microtubule-associated protein 1 light chain 3 beta （LC3B） and cytochrome c oxidase subunit Ⅳ （COX Ⅳ）. ResultsCompared with the normal control group， the model group exhibited significant increases in renal index， blood glucose， and 24-hour urinary microalbumin （24 h mALB） （P<0.05， P<0.01）. The levels of serum SCr and BUN were significantly elevated （P<0.01）， and the serum levels of TNF-α， IL-1β， and IL-6 were markedly upregulated （P<0.01）. Histopathological examination revealed glomerular hypertrophy， mesangial expansion and increased deposition， podocyte foot process flattening and fusion， a decreased number of autophagosomes accompanied by mitochondrial swelling， vacuolar degeneration of renal tubular epithelial cells， and inflammatory cell infiltration in the renal interstitium. The expression levels of autophagy-related proteins LC3B， PTEN-induced putative kinase 1 （PINK1）， and E3 ubiquitin-protein ligase （Parkin） were significantly decreased （P<0.05， P<0.01）， while expression of the selective autophagy adaptor protein p62 was significantly increased （P<0.01）. Immunofluorescence signal intensity and LC3B-COX Ⅳ co-expression were both diminished. Compared with the model group， the MSJS treatment groups and the irbesartan group showed significant reductions in renal index， blood glucose， and 24 h mALB （P<0.05， P<0.01）. The serum SCr and BUN levels decreased significantly （P<0.05） and TNF-α， IL-1β， and IL-6 levels were significantly downregulated （P<0.05， P<0.01）. Histopathological damage was alleviated， including reduced glomerular hypertrophy， decreased mesangial deposition， and attenuated podocyte foot process fusion. The number of autophagosomes increased， and mitochondrial swelling was improved. The expression levels of LC3B， PINK1， and Parkin in renal tissues were significantly upregulated， whereas p62 expression was significantly downregulated （P<0.05， P<0.01） in MSJS groups. Immunofluorescence signal intensity was enhanced， and LC3B-COX Ⅳ co-expression was increased. ConclusionMSJS alleviates the inflammatory response in DKD rats and exerts renal protective effects by regulating the PINK1/Parkin signaling pathway and activating mitochondrial autophagy.

ObjectiveTo investigate the mechanism by which modified Shengjiangsan （MSJS） improves diabetic kidney disease （DKD） by activating mitochondrial autophagy. MethodsSixty SPF-grade male Sprague-Dawley rats aged 7-8 weeks were selected. A DKD model was established using a high-sugar， high-fat diet combined with intraperitoneal injection of streptozotocin （STZ）. After successful modeling， the rats were randomly divided into six groups： a normal control group， a model group， low-， medium-， and high-dose MSJS groups （7.7， 15.4， 30.8 g·kg^-1， respectively）， and an irbesartan group （0.384 g·kg^-1）. Each group received either normal saline or the corresponding drug by gavage once daily for 28 consecutive days. Blood glucose， body weight， and kidney weight were recorded. Serum creatinine （SCr） and blood urea nitrogen （BUN） levels were detected using an automatic blood analyzer. Enzyme-linked immunosorbent assay （ELISA） was used to determine urinary microalbumin （mALB）， and serum levels of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-6 （IL-6）. Histopathological changes in renal tissues were observed using hematoxylin-eosin （HE） staining， periodic acid-Schiff （PAS） staining， and transmission electron microscopy （TEM）. The expression levels of mitochondrial autophagy-related proteins in renal tissues were analyzed by Western blot. Immunofluorescence co-localization was employed to detect the co-expression of microtubule-associated protein 1 light chain 3 beta （LC3B） and cytochrome c oxidase subunit Ⅳ （COX Ⅳ）. ResultsCompared with the normal control group， the model group exhibited significant increases in renal index， blood glucose， and 24-hour urinary microalbumin （24 h mALB） （P<0.05， P<0.01）. The levels of serum SCr and BUN were significantly elevated （P<0.01）， and the serum levels of TNF-α， IL-1β， and IL-6 were markedly upregulated （P<0.01）. Histopathological examination revealed glomerular hypertrophy， mesangial expansion and increased deposition， podocyte foot process flattening and fusion， a decreased number of autophagosomes accompanied by mitochondrial swelling， vacuolar degeneration of renal tubular epithelial cells， and inflammatory cell infiltration in the renal interstitium. The expression levels of autophagy-related proteins LC3B， PTEN-induced putative kinase 1 （PINK1）， and E3 ubiquitin-protein ligase （Parkin） were significantly decreased （P<0.05， P<0.01）， while expression of the selective autophagy adaptor protein p62 was significantly increased （P<0.01）. Immunofluorescence signal intensity and LC3B-COX Ⅳ co-expression were both diminished. Compared with the model group， the MSJS treatment groups and the irbesartan group showed significant reductions in renal index， blood glucose， and 24 h mALB （P<0.05， P<0.01）. The serum SCr and BUN levels decreased significantly （P<0.05） and TNF-α， IL-1β， and IL-6 levels were significantly downregulated （P<0.05， P<0.01）. Histopathological damage was alleviated， including reduced glomerular hypertrophy， decreased mesangial deposition， and attenuated podocyte foot process fusion. The number of autophagosomes increased， and mitochondrial swelling was improved. The expression levels of LC3B， PINK1， and Parkin in renal tissues were significantly upregulated， whereas p62 expression was significantly downregulated （P<0.05， P<0.01） in MSJS groups. Immunofluorescence signal intensity was enhanced， and LC3B-COX Ⅳ co-expression was increased. ConclusionMSJS alleviates the inflammatory response in DKD rats and exerts renal protective effects by regulating the PINK1/Parkin signaling pathway and activating mitochondrial autophagy.

Vaccination is an effective measure to control infectious diseases and provides lifelong health protection for the public. In recent years, vaccination for adults, especially the elderly, has gradually attracted attention in China, but its vaccination rate is significantly lower than that in some developed countries. To improve adult vaccine coverage, an immunization service model featuring adult vaccine prescriptions has been explored in some provinces of China. This study describes the implementation and characteristics of an adult vaccine prescription pilot program in Shandong Province and discusses considerations related to the concept, compliance, advantages, and difficulties of the vaccine prescription model. Suggestions for developing the vaccine prescription system in China are also provided.

In recent years,the incidence of atherosclerotic occlusive disease of lower extremity has been steadily increasing.The treatment methods for lower limb atherosclerotic occlusive disease,including medication therapy,endovascular treatment,hybrid surgery,etc.,have been constantly improved and innovated.Currently,endovascular therapy has become the mainstream treatment method,However,the postoperative re-intervention rate with endovascular therapy is still not ideal,and the patient's prognosis is also unsatisfactory.Meanwhile,numerous studies on the postoperative restenosis-related biomarkers have been reported,and new management concepts and new methods are also constantly emerging.This paper aims to explore the risk factors of postoperative restenosis and its related biomarkers by analyzing recent literature,to compare the re-intervention risk among different treatment approaches,and to expect new treatment methods as well as effective management of prognosis in the future.

Objective:To explore the related risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive Mckeown esophagectomy (MIME).Methods:This is a retrospective controlled study. A retrospective analysis was conducted on the clinical data of patients who underwent MIME at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, from January 2016 to December 2023. A total of 619 patients were included. There were 423 males and 196 females, aged (63.7±7.6) years (range: 37 to 87 years). The diagnosis of diaphragmatic hernia after MIME was made based on clinical symptoms and CT scans. Patients were divided into two groups: the diaphragmatic hernia group ( n=16) and the non-diaphragmatic hernia group ( n=603). Clinical data, including age, gender, body mass index (BMI), smoking history, tumor location (upper, middle, and lower thoracic esophagus), preoperative neoadjuvant therapy history, and tumor staging, were collected and analyzed. A BMI of 25 kg/m2 and age of 65 years were used as cutoff values. The χ2 test and Fisher′s exact test were used to compare the data between the two groups, and Logistic regression was employed for risk factor analysis. The diaphragmatic hernia group and non-diaphragmatic hernia group were matched in a 1∶3 ratio with a caliper value of 0.02 by propensity score matching. Kaplan-Meier method was used for survival analysis and compared using the log-rank test for between-group differences. Results:The proportion of patients with diaphragmatic hernia after MIME who underwent surgical treatment was 6/16. Statistically significant differences were observed between the diaphragmatic hernia group and the non-diaphragmatic hernia group in terms of age ( χ2=16.057, P<0.01), BMI ( χ2=16.057, P<0.01), and tumor location ( χ2=12.048, P=0.002). Multivariate logistic regression analysis revealed that age ≥65 years ( OR=1.236, P=0.023) and BMI<25 kg/m2 ( OR=0.810, P<0.01) were independent risk factors for the development of diaphragmatic hernia after MIME. Survival analysis showed no significant difference in long-term survival between patients with and without diaphragmatic hernia after MIME ( P=0.187), and whether patients with diaphragmatic hernia underwent surgery was not associated with long-term prognosis ( P=0.560). Conclusion:Patients with BMI<25 kg/m 2 and age ≥65 years are independent risk factors for diaphragmatic hernia after MIME. The occurrence of diaphragmatic hernia is not associated with prognosis, and whether patients with diaphragmatic hernia undergo surgery does not affect the prognosis.

Objective:To evaluate the efficacy and safety of immunotherapy combined with chemotherapy as conversion therapy for initially unresectable locally advanced esophageal squamous cell carcinoma.Methods:This retrospective case series study analyzed clinical and pathological data of 32 patients with initially unresectable locally advanced esophageal squamous cell carcinoma who received immunotherapy combined with chemotherapy at the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, from June 2020 to December 2024. The cohort included 27 males and 5 females, with an age ( M(IQR)) of 61(9)years (range:46 to 73 years). Five patients were diagnosed with stage Ⅲ, 27 with stage ⅣA. All patients received PD-1 inhibitor sintilimab combined with nedaplatin and albumin-bound paclitaxel. Radiological evaluations were performed every two cycles, the multidisciplinary team evaluation was conducted to determine conversion to resectable status, and patients with successful conversion underwent radical esophagectomy. Follow-up was conducted via telephone or outpatient visits every 3 to 6 months after the last treatment. The primary endpoint was R0 resection rate, secondary endpoints included objective response rate (ORR), pathological complete response (pCR) rate, major pathological response (MPR) rate, event-free survival (EFS), disease-free survival (DFS) in patients with R0 resection, overall survival (OS) and safety. Kaplan-Meier method was used to plot survival curves and estimate median EFS, DFS, OS rates and their 95% CI. The 95% CI for ORR, pCR rate, MPR rate, and downstaging rate were calculated using the Clopper-Pearson method. Results:The median treatment cycle of 2(1) (range:2 to 8). As of June 2025, the median follow-up was 32.5(13.5)months (range:6.4 to 59.1 months). Among the 32 patients, 9 experienced progression or recurrence, including 2 with liver and lymph node metastases, 2 with lung metastases, 2 with thoracic vertebral metastases, and 3 with mediastinal lymph node metastases. After conversion therapy, 29 patients underwent surgery, achieving an R0 resection rate of 84.4% (95% CI:67.2% to 94.7%), a pCR rate of 27.6% (95% CI:12.7% to 47.2%), and an MPR rate of 55.2% (95% CI:35.7% to 73.6%). Grade 3 or higher surgical complications occurred in 6.9%(2/29) of patients, and grade 3 or higher treatment-related adverse events were observed in 15.6%(5/29). Among the 32 patients, the ORR was 56.3% (95% CI:37.7% to 73.6%),the 3-year EFS rate and OS rate was 59.4% (95% CI:40.8% to 86.4%) and 59.7% (95% CI:40.0% to 89.0%) respectively. Conclusion:Immunotherapy combined with chemotherapy demonstrates high conversion rates and favorable safety in the conversion therapy of initially unresectable locally advanced esophageal squamous cell carcinoma, representing a promising treatment strategy.

Objective:To analyze the APR triangle formed when the right hepatic vein (RHV) passed through the right anterior hepatic pedicle (RAHP) and the right posterior hepatic pedicle (RPHP) by 3D visualization technique.Methods:Clinical data of 100 subjects undergoing liver contrast-enhanced CT scan in the Second Affiliated Hospital of Harbin Medical University from September 2019 to September 2022 were retrospectively analyzed, including 57 males and 43 females, aged (53.2±13.0) years. The CT data were imported into a system for 3D image reconstruction of the liver. The intrahepatic vascular structure was observed, including the portal vein, APR triangle, the angle between the RAHP and RPHP, the distance between RHV and the vertex of angle when it crosses the angle plane of the RAHP and RPHP, the structure and branches of the right posterior branch of portal vein, and the number of branches into the APR triangle from the main trunk of the right anterior and right posterior portal vein.Results:The main type of portal vein was type A (the main portal vein was divided into left and right branches, and the right branch was further divided into right anterior branch and right posterior branch), in 86 cases (86.0%). The APR triangle was observed in 81 cases (81.0%), and the distance between the right hepatic vein and the vertex of the right anterior and right posterior hepatic pedicle was (1.70±0.36) cm, 1.00-2.00 cm was 82.7%(61/81). The angle between right anterior and right posterior hepatic pedicle was 45°-90° in 77 cases (77.0%, 77/100). In 100 subjects, the main branch of the right posterior portal vein accounted for 42.0% (42/100) of typeⅠ (bifurcation type) and 53.0% (arch type) of type Ⅱ (53/100). In 16 cases (19.8%, 16/81), the main right anterior portal vein branched into the APR triangle, with a total of 22 branches. In 9 cases (11.1%, 9/81), the main branch of the right posterior portal vein (branching type) branched into the triangle, with a total of 11 branches. There were 33 cases (40.7%, 33/81) of right posterior portal vein (arch type) main branch branching into the triangle, a total of 41 branches.Conclusion:The APR triangle, composed of the RAHP, RPHP and RHV, has an objective anatomical basis and is affected by the variants of portal vein and RHV. It is more common for the RHV to be within 1.00-2.00 cm of the vertex of the angle between the RAHP and RPHP, and the main trunk of the right anterior and right posterior branches of portal vein are less divided into the triangle, so it is relatively safe to dissect within this area.

Objective:To evaluate the short-term efficacy of minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures in diabetes patients using subtalar arthroscopy assisted by preoperative musculoskeletal ultrasound to localize the lateral calcaneal branch of the sural nerve and a medial calcanetalar distractor.Methods:The clinical data of the 52 patients with diabetes mellitus were retrospectively analyzed who had been treated for Sanders Ⅱ and Ⅲ calcaneal fractures from March 2016 to August 2020 at Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University. There were 34 males and 18 females with an age of (61.7±14.5) years. According to the Sanders' classification, there were 23 cases of type Ⅱ and 29 cases of type Ⅲ. Preoperative musculoskeletal ultrasonography was routinely performed to locate the lateral calcaneal branch of the sural nerve in all patients. The surgical procedures were subtalar arthroscopy combined with percutaneous prying reduction and screw fixation assisted by a calcanetalar joint distractor. Incision healing, local skin paraesthesia and other conditions were observed regularly in all patients. The short-term efficacy was assessed by comparing calcaneal lengths, calcaneal widths, calcaneal heights, B?hler angles and Gissane angles at pre-surgery, 3 days, 12 months and the last follow-up after surgery, as well as by comparing visual analogue scale (VAS) pain scores, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and Maryland scores at pre-surgery, 12 months and the last follow-up after surgery.Results:All the 52 patients were followed up for (23.7±3.2) months after successful surgery. No incision-related complications were reported. The calcaneal radiographic parameters (calcaneal lengths, calcaneal widths, calcaneal heights, B?hler angles and Gissane angles) at 3 days, 12 months and the last follow-up after surgery were significantly improved compared with the values before surgery ( P<0.05), but there were no significant differences regarding the calcaneal radiographic parameters between 3 days, 12 months and the last follow-up after surgery ( P>0.05). The VAS pain scores, AOFAS ankle-hindfoot scores and Maryland scores at 12 months and the last follow-up after surgery were significantly improved compared with those before surgery ( P<0.05). Conclusion:In the minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures in diabetes patients, preoperative musculoskeletal ultrasonography to locate the lateral calcaneal branch of the sural nerve, followed by subtalar arthroscopy combined with percutaneous prying reduction and screw fixation assisted by a calcanetalar joint distractor can lead to good short-term efficacy.

Vaccination is an effective measure to control infectious diseases and provides lifelong health protection for the public. In recent years, vaccination for adults, especially the elderly, has gradually attracted attention in China, but its vaccination rate is significantly lower than that in some developed countries. To improve adult vaccine coverage, an immunization service model featuring adult vaccine prescriptions has been explored in some provinces of China. This study describes the implementation and characteristics of an adult vaccine prescription pilot program in Shandong Province and discusses considerations related to the concept, compliance, advantages, and difficulties of the vaccine prescription model. Suggestions for developing the vaccine prescription system in China are also provided.

Objective:To evaluate the short-term efficacy of minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures in diabetes patients using subtalar arthroscopy assisted by preoperative musculoskeletal ultrasound to localize the lateral calcaneal branch of the sural nerve and a medial calcanetalar distractor.Methods:The clinical data of the 52 patients with diabetes mellitus were retrospectively analyzed who had been treated for Sanders Ⅱ and Ⅲ calcaneal fractures from March 2016 to August 2020 at Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University. There were 34 males and 18 females with an age of (61.7±14.5) years. According to the Sanders' classification, there were 23 cases of type Ⅱ and 29 cases of type Ⅲ. Preoperative musculoskeletal ultrasonography was routinely performed to locate the lateral calcaneal branch of the sural nerve in all patients. The surgical procedures were subtalar arthroscopy combined with percutaneous prying reduction and screw fixation assisted by a calcanetalar joint distractor. Incision healing, local skin paraesthesia and other conditions were observed regularly in all patients. The short-term efficacy was assessed by comparing calcaneal lengths, calcaneal widths, calcaneal heights, B?hler angles and Gissane angles at pre-surgery, 3 days, 12 months and the last follow-up after surgery, as well as by comparing visual analogue scale (VAS) pain scores, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and Maryland scores at pre-surgery, 12 months and the last follow-up after surgery.Results:All the 52 patients were followed up for (23.7±3.2) months after successful surgery. No incision-related complications were reported. The calcaneal radiographic parameters (calcaneal lengths, calcaneal widths, calcaneal heights, B?hler angles and Gissane angles) at 3 days, 12 months and the last follow-up after surgery were significantly improved compared with the values before surgery ( P<0.05), but there were no significant differences regarding the calcaneal radiographic parameters between 3 days, 12 months and the last follow-up after surgery ( P>0.05). The VAS pain scores, AOFAS ankle-hindfoot scores and Maryland scores at 12 months and the last follow-up after surgery were significantly improved compared with those before surgery ( P<0.05). Conclusion:In the minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures in diabetes patients, preoperative musculoskeletal ultrasonography to locate the lateral calcaneal branch of the sural nerve, followed by subtalar arthroscopy combined with percutaneous prying reduction and screw fixation assisted by a calcanetalar joint distractor can lead to good short-term efficacy.