Rheumatoid arthritis （RA） is a chronic autoimmune disease characterized by synovitis as its pathological basis. Although current therapeutic drugs can alleviate symptoms， they are often accompanied by a high risk of side effects. In recent years， the use of flavonoids from traditional Chinese medicine （TCM） in the treatment of RA has garnered significant attention. Studies have shown that the mechanisms by which flavonoids treat RA include inhibiting the release of pro-inflammatory factors， regulating multiple cellular signaling pathways， alleviating oxidative stress， modulating immune system functions， inhibiting bone destruction， and suppressing angiogenesis. Due to their notable anti-inflammatory， antioxidant， and immunomodulatory activities， flavonoids hold promise as potential therapeutic agents for RA. A substantial number of articles in this field have been published. By reviewing Chinese and international literature and applying bibliometric and visual analysis using CiteSpace， this paper explored research hotspots and frontiers in this field， systematically reviewed the structures and anti-RA mechanisms of TCM flavonoids， provided a theoretical basis for their use in RA treatment and clinical applications， and offered new perspectives and references for the discovery of novel TCM-based anti-RA drugs.

Rheumatoid arthritis （RA） is a chronic autoimmune disease characterized by synovitis as its pathological basis. Although current therapeutic drugs can alleviate symptoms， they are often accompanied by a high risk of side effects. In recent years， the use of flavonoids from traditional Chinese medicine （TCM） in the treatment of RA has garnered significant attention. Studies have shown that the mechanisms by which flavonoids treat RA include inhibiting the release of pro-inflammatory factors， regulating multiple cellular signaling pathways， alleviating oxidative stress， modulating immune system functions， inhibiting bone destruction， and suppressing angiogenesis. Due to their notable anti-inflammatory， antioxidant， and immunomodulatory activities， flavonoids hold promise as potential therapeutic agents for RA. A substantial number of articles in this field have been published. By reviewing Chinese and international literature and applying bibliometric and visual analysis using CiteSpace， this paper explored research hotspots and frontiers in this field， systematically reviewed the structures and anti-RA mechanisms of TCM flavonoids， provided a theoretical basis for their use in RA treatment and clinical applications， and offered new perspectives and references for the discovery of novel TCM-based anti-RA drugs.

Objective:To investigate the surgical outcomes of acetabular posterior wall fractures in patients aged 50 and above.Methods:A retrospective study was conducted to analyze the clinical data of 67 patients with acetabular posterior wall fracture who had been treated through the Kocher-Langenbeck approach and fully followed up from August 2003 to November 2021. There were 54 males and 13 females, aged 59.0 (54.0, 63.0) years. The time from injury to surgery was 8.0 (5.0, 13.0) days. Open reduction and internal fixation was performed for 63 cases and hip arthroplasty for 4 cases by one stage. The operation time, intraoperative bleeding, quality of postoperative fracture reduction, recovery of hip function at the last follow-up, and incidence of complications during the follow-up period were recorded.Results:The operation time for the 67 patients was 90.0 (67.5, 101.3) min, and the intraoperative bleeding 350.0 (300.0, 450.0) mL. According to the Matta criteria, 63 patients with internal fixation achieved anatomical reduction. All the 67 patients were followed up for (112.8±62.4) months. According to the modified Merle d'Aubigné & Postel scoring system, the function of the affected hip was assessed at the last follow-up in the 63 patients with internal fixation as excellent in 56 cases, as good in 3 cases, as fair in 2 cases, and as poor in 2 cases, giving an excellent and good rate of 93.6% (59/63). The prostheses survived in all the 4 patients who underwent one-stage hip replacement, with hip Harris scores of 94, 92, 91, and 93, respectively. Complications included 15 cases (23.8%, 15/63) of heterotopic ossification and 1 case (1.6%, 1/63) of transient sciatic nerve palsy. Femoral head ischemic necrosis and traumatic arthritis occurred in 2 patients (3.2%, 2/63) who had to receive total hip arthroplasty 3 years after surgery.Conclusion:Open reduction and internal fixation is still the main treatment method for acetabular posterior wall fractures in patients aged 50 and above, because it can achieve good clinical outcomes and help the patients recover joint function and quality of life at an early stage.

Clinical data of 210 patients with early colorectal cancer and precancerous lesion treated by endoscopic submucosal dissection (ESD) in the Digestive Endoscopy Center of the Seventh Medical Center of Chinese PLA General Hospital from January 2015 to March 2018 were collected and analyzed retrospectively. Patients were divided into two groups according to the age: the elderly group (≥65 years old, 100 cases) and the non-elderly group (<65 years old, 110 cases). The en bloc resection rate, complete resection rate,and curative resection rate of the elderly group were 92.0% (92/100), 91.0% (91/100) and 89.0% (89/100), respectively. The above indicators of the non-elderly group were 90.9% (100/110) ( P=0.972), 90.0% (99/110) ( P=0.991) and 88.2% (97/110) ( P=1.000), respectively. The incidence of intraoperative perforation in the elderly group was 4.0% (4/100) and in the non-elderly group was 6.4% (7/110) ( P=0.543). Delayed postoperative bleeding rate was 2.0% (2/100) in the elderly group, and 0 (0/110) in the non-elderly group ( P=0.226). ESD is effective and safe in treating early colorectal cancer and precancerous lesion in elderly patients.

Objective To compare the effects of different hemodialysis methods on vitamin K2and abdomi-nal aortic calcification.Methods From January 2016 to June 2017,collect 60 maintenance hemodialysis(MHD) patients in the First Affiliated Hospital of Shihezi University,including low flux hemodialysis(HD)patients with 30 cases and high flux hemodialysis(HFHD)patients with 30 cases.Selecting 30 cases as healthy group and con-trol group with similar sex and age.Blood biochemical detection of serum calcium,phosphorus,magnesium,albu-min,parathyroid hormone and other indicators were deternmined.Detecting the abdominal aortic calcification score calculation with abdominal lateral X-ray.Detecting serum vitamin K2levels in the three groups with ELISA.Further analyzing the correlation between vitamin K2levels and abdominal aortic calcium integration. Results Firstly, compared with the control group,vitamin K2levels in group HD and group HFHD were decreased(P<0.05).Vi-tamin K2levels in group HD were lower than those in group HFHD(P<0.05).Secondly,the score of abdominal aorta calcification in group HD was higher than that in group HFHD(P<0.05).Thirdly,levels of vitamin K2and abdominal aortic calcification score were negatively correlated(r =-0.319,P < 0.05),and 25(OH)VD3,calci-um,phosphorus,magnesium,calcium and phosphorus product,parathyroid hormone had no correlation(P >0.05). Conclusion In MHD patients,the level of vitamin K2in HFHD group is higher than that in HD group, the abdominal aortic calcification score is lower than that of HD group,and vitamin K2can delay the process of vas-cular calcification.

Objective To investigate the clinical efficacy of three-dimensional (3D) laparoscopic surgery in treatment of hepatic cystic echinococcosis.Methods The retrospective cross-sectional study was conducted.The clinical data of 40 patients with hepatic cystic echinococcosis who underwent 3D laparoscopic surgery in the Qinghai Province People's Hospital from March 2016 to July 2017 were collected.All the 40 patients were treated using 100 mg hydrocortisone on preventing intraoperative anaphylaxis.The experienced surgeons with proficiency in the laparoscopic technology in the same team finished surgery.Patients underwent respectively 3D laparoscopic excision of internal capsule in hepatic echinococcosis + residual cavity treatment,external capsule resection in hepatic echinococcosis and partial hepatectomy based on their conditions.Observation indicators:(1) intraoperative situations:operation completion,surgical procedures,operation time,volume of intraoperative blood loss and blood transfusion;(2) postoperative recovery situations:time to initial anal exsufflation,time for initial fluid diet intake,time for out-of-bed activity,time of indwelling drainage-tube,wound healing,postoperative complications and duration of postoperative hospital stay;(3) follow-up:number of patients with follow-up,follow-up time,oral anti-echinococcosis medical therapy during follow-up,hepatic echinococcosis recurrence and abdominal cavity implantation metastasis.Follow-up using outpatient examination and telephone interview was performed to detect the abdominal symptoms,oral anti-echinococcosis medicine,hepatic echinococcosis recurrence and metastasis up to September 2017.Measurement data with normal distribution were represented as (x)± s.Measurement data with skewed distribution were described as M (range).Results (1) Intraoperative situations:all the 40 patients underwent successful laparoscopic surgery,including 17 undergoing excision of internal capsule in hepatic echinococcosis + residual cavity treatment,15 undergoing external capsule resection in hepatic echinococcosis and 8 undergoing partial hepatectomy.Two patients were combined with abdominal and pelvic hydatids and underwent 3D laparoscopic excision.Operation time and volume of intraoperative blood loss of 40 patients were respectively (100 ± 28) minutes and (86± 24) mL,without intraoperative blood transfusion.(2) Postoperative recovery situations:time to initial anal exsufflation and time for initial fluid diet intake in 40 patients were (2.4± 1.8)hours and (1.7±0.9)days.Forty patients had out-of-bed activity on the day of surgery.Of 40 patients,abdominal drainage-tubes of 39 were placed for 2-3 days;abdominal drainage-tube of 1 with postoperative residual cavity-induced bile leakage was indwelled for 2 months and then was removed.Wound healing and duration of postoperative hospital stay in 40 patients were Class-A healing and (10.5 ± 2.1) days.During hospitalization,39 patients didn't have bleeding,bile leakage,anaphylactic shock,intestinal adhesion and obstruction;1 patient with postoperative residual cavity-induced bile leakage had indwelling drainage-tube removal at 2 months postoperatively.(3) Follow-up:all patients were followed up for 2-15 months,with a median time of 9 months.During the follow-up,40 patients were not complicated with discomforts and received oral antiechinococcosis medical therapy,without hepatic echinococcosis recurrence and abdominal cavity implantation metastasis.Conclusion The 3D laparoscopic surgery is safe and feasible in the treatment of hepatic cystic echinococcosis,and has an obvious advantage in the treatment of irregular hepatic cystic echinococcosis,with good short-term outcomes.

Objective To analyze the distribution of microorganisms in kidney perfusion fluid and perirenal drainage of the renal allografts,and provide evidence to guide clinical practice.Methods The clinical data from the kidney donors and the recipients,the microbiologic culture results of kidney perfusion fluid and perirenal drainage were retrospectively analyzed.Results Ninety-one kidney perfusion fluid samples and 91 perirenal drainage samples were collected from 61 individual renal allografts,and 48 renal allografts were paired.Fourteen (15.4％,14/91) cultured kidney perfusion fluid samples were positive,17 strains were confirmed including 13 strains of bacteria and 4 strains of fungal,and 9 (69.2％,9/13) of bacterial strains were multidrug-resistance with 7 strains resistant to carbapenems,but there was no significant heterogeneity in the outcome of recipients with positive or negative culture results of kidney perfusion fluid samples.Eight (8.8％,8/91) perirenal drainage samples from different recipients were positive,5 of 8 bacterial strains were multidrug-resistance and 3 of them were resistant to carbapenems including meropenem or imipenern.There was no significant correlation between the length of donors' hospital stay and the culture results (P＞0.05),and there was also no significant correlation between the length of recipients' hospital stay after transplantation and the culture results (P＞0.05).Conclusion The kidney with positive perfusion fluid microbiologic culture can be transplanted safely using the prophylaxis or preemptive anti-infection therapy.

Objective To investigate the effect of laparoscopic lymphadenectomy in patients with adenocarcinoma of esophagastric junction (AEG).Methods 105 patients with AEG underwent open or laparoscopic surgery from June 2014 to September 2015 were enrolled in the study and divided into minimally invasive group (n = 70) and laparotomy group (n = 35). The baseline data, lymphadenectomy result and perioperative data were compared between the two groups.Results Total number of splenic hilar lymph nodes dissection in minimally invasive group was significantly more than that in laparotomy group (P < 0.05). But there were no significant differences in the total number of lymph node dissection, number of positive lymph node dissection, positive rate of all node, number of positive splenic hilar lymph node dissection and positive ratef of splenic hilar lymph node between two groups (P > 0.05). Operation time, intraoperative blood loss, length of incision, positive proximal margins rate, thoracoabdominal resection rate and spleen resection rate in minimally invasive group were significantly lower than that in laparotomy group, esophagus resection length was significantly bigger than that in laparotomy group (P < 0.05). No death occurred postoperatively in all patients. The time of anus exsufflation, first intake liquid diet and postoperative ambulatory episode in minimally invasive group were significantly lower than that in laparotomy group (P < 0.05). There were no significant differences in the incidence of complications between two groups (P > 0.05).Conclusions Compared with open surgery, laparoscopic surgery is superior in splenic hilar lymph nodes dissection of AEG, with longer esophageal cutting distances, lower thoracoabdominal resection and spleen resection rate. It is safe and feasible, worthy of clinical promotion.

Objective To compare the clinical efficacy of kidney transplantations from donors with acute kidney injury (AKI) and without AKI,and summarize the experience of evaluation and application.Methods The clinical data of 240 kidney transplantations from donation after citizen's death (DCD) performed in our hospital between November 2011 and March 2015 were retrospectively analyzed.The recipients were classified into AKI group (n =37) and non-AKI group (n =203) according to donors' renal function and urine output.Basic characteristics and evolution of the donors and recipients were compared between the two groups.Results The donor serum creatinine was significantly higher in the AKI group than that in the non-AKI group (P＜0.01).Most transplant recipients accepted ATG for immune induction therapy in the AKI group,while Basiliximab was given in the non-AKI group,which was significantly different (P＜0.01).Delayed graft function developed more frequently and longer in the AKI group than in the non-AKI group (P＜0.01).However,patient and graft survival rates did no differ between the AKI and non-AKI groups (P＞0.05).There was no significant difference in other indexes between the two groups (P＞0.05).Conclusion The transplants from donors with AKI showed higher incidence of delayed graft function but no effect on 1-year allograft and patient survival.This type of kidney transplantation is safe and effective.

Objective To explore the prevention and treatment strategies for the infectious renal artery rupture after renal transplantation of organ donation after citizens death (DCD).Methods The clinical data of 5 donors and their corresponding recipients with infectious renal artery rupture after renal transplantation were retrospectively analyzed with review of the literature.Results The corresponding donors of 5 recipients had the potential risk factors for donor-transmitted infection (DTI):1 case of traumatic rupture of small intestine,2 cases of digestive tract injury when resecting the donor kidney from DCD donors,1 case of severe pneumonia and 1 case of multiple renal contusion.The pathogenic microorganisms were found in the culture of kidney preservation solution,including klebsiella pneumoniae in 1 case,candida albicans in i case,enterococcus.No pathogens were detected in 1 case,and kidney preservation solution taken from the external hospital was not cultured in 1 case.The pathological examination on the resected renal grafts revealed the necrosis of the arteries and the infiltration of lymphocytes.The culture of bacteria and fungi in the removed vessel walls of renal grafts and the iliac tissues showed there were 2 cases positive for candida albicans (case 2 and case 4),1 case for cryptococcus neoformans (case 1),1 case for klebsiella pneumonia (case 5).No pathogenic bacteria were detected in 1 case,but the possibility of fungal infection was more likely.In case 1,the second kidney transplantation was performed 10 months later after artery re-transplantation,and the kidney function was normal during the follow-up period.In case 4,the second kidney transplantation was performed 2 months later after transplant nephrectomy due to the refractory rejection,the transplanted kidney experienced a rapid loss of graft function,and the blood dialysis was given continuously.The remaining 3 patients survived so far,waiting for re-transplantation.No case of bleeding occurred again in the 5 recipients.Conclusion Renal graft artery rupture is one of most severe complications after renal transplantation.It is the key for preventing infectious renal artery rupture to screen strictly infection of donors and recipients,and to use sensitive and wide coverage antimicrobial to the donors before the removal of donor kidney and during the perioperative period after renal transplantation.Early detection and operation as soon as possible is the only treatment to save the lives of the recipients.