Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Purpose: This retrospective study aimed to re-evaluate the effect of concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). Materials and Methods: A total of 498 patients who received neoadjuvant chemotherapy (NCT) combined with concurrent chemoradiotherapy (CCRT) or IMRT were retrospectively reviewed. The distribution of baseline characteristics was balanced using propensity score matching. Additionally, the results of NCT+IMRT and NCT+CCRT were compared using Kaplan-Meier survival analysis, and differences in survival rates were analyzed using the log rank test. Results: There were no significant differences in overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LRFS) between the two groups. Patients were further categorized into risk subgroups based on pretreatment Epstein-Barr virus (EBV) DNA cutoff values using receiver operating characteristic curve analysis. There were no statistically significant differences in OS, PFS, DMFS, and LRFS between patients who received NCT+CCRT and NCT+IMRT in the high-risk group. In the low-risk group, although there were no differences between NCT+CCRT and NCT+IMRT in OS, PFS, and LRFS, patients who received NCT+CCRT had better DMFS than those who received NCT+IMRT. Conclusion Pretreatment EBV DNA level can be used to individualize concurrent chemotherapy for patients with locally advanced NPC. Patients with low pretreatment EBV DNA levels may benefit from concurrent chemotherapy, whereas those with high levels may not. Other treatment modalities need to be explored for high-risk patients to improve their prognosis.

Methods:Whole blood and serum samples were collected from 86 patients with HBV-ACLF and 42 patients with chronic hepatitis B (CHB). Serum alanine aminotransferase (ALT), total bilirubin (TBil), creatinine (Cr), albumin (ALB) cholinesterase (CHE) and international standardized ratio (INR) were detected by routine method . The CXCL10 mRNA level of peripheral blood mononuclear cells was detected by fluorescence quantitative PCR. The genotype and allele of rs56061981 were detected by direct DNA sequencing. The genotype and allele frequencies between the ACLF and CHB groups were compared. The levels of ALT, TBil, INR, ALB, CHE, model for end-stage liver disease (MELD) and CXCL10 mRNA were compared between the two groups according to whether the T allele was carried.Results:There was no significant difference in sex, age, alcohol history, smoking history, HBV genotype, HBeAg status and HBV-DNA level between CHB group and HBV-ACLF group (P > 0.05). The frequency of CT+ TT genotype and the frequency of T allele at the rs56061981 locus of the CXCL10 gene in group ACLF were significantly higher than that in the CHB group ( χ2=4.83, P=0.03 and χ2=4.95, P=0.03). The difference is significant Genotype CT+ TT is a risk factor for CHB to develop into HBV-ACLF ( OR=2.897, 95% CI: 1.09~7.68). Allele T is a risk factor for CHB to develop into HBV-ACLF ( OR=2.746, 95% CI: 1.10~6.89). The plasma INR and MELD scores of ACLF individuals carrying T alleles were significantly higher than those carrying C alleles (t=2.63, P=0.013 and t=2.7, P=0.011). The difference is significant. Albumin (ALB) and cholinesterase (CHE) was significantly lower than those carrying C alleles (t=2.67, P=0.01 and t=3.545, P=0.001). The difference is significant. But there was no significant difference in serum TBL and ALT between the two groups. Conclusions:The polymorphism of CXCL10 gene rs56061981 is significantly correlated with the susceptibility and severity of ACLF. Allele T may be a susceptible gene of ACLF, and it can also be used as a predictor of the severity of the disease.

Objective:To investigate the clinical manifestations, imaging features, histopathologic, immunohistochemical (IHC) and ultrastructure features of neuronal intranuclear inclusion disease (NIID).Methods:HE, IHC staining and EM were performed in cases of NIID diagnosed at the Department of Pathology, Jinling Hospital from 2018 to 2019.Results:Two cases were identified, including one male and one female; both patients were 76 years old. They were hospitalized because of nervous system dysfunction. MRI showed abnormal high signal intensity in corticomedullary junction of bilateral frontal lobes (male patient) and bilateral cerebral hemispheres (female patient). Light eosinophilic transparent inclusion bodies were seen in the nuclei of neurons in both rectal mucosa and cutaneous sweat glands, and these were positive for p62 by IHC. By scanning EM, the inclusion bodies in the sweat gland cells nuclei were round membranous structures consisting of 8-18 nm microfilaments.Conclusions:NIID is a rare, multi-system and slowly progressive neurodegenerative disease. Its clinical manifestations are highly diverse and easily misdiagnosed or missed. Neuroimaging can make a preliminary diagnosis. In the past, NIID can only be diagnosed through autopsy, and this study demonstrates that NIID can be confirmed through skin or rectal mucosal biopsy.

Objective: To investigate the clinical value of plasma EBV DNA in monitoring clinical efficacy in the treatment of nasopharyngeal carcinoma (NPC). Methods: Clinical data of 799 patients initially diagnosed with NPC treated with radical intensity-modulated radiotherapy (IMRT) in our hospital from 2016 to 2017 were analyzed retrospectively. Prior to treatment, the correlation between plasma EBV DNA, clinical stage and tumor progression was analyzed. The relationship between EBV DNA and tumor progression was analyzed after radiotherapy and during follow-up. Results: Before IMRT, the level of EBV DNA was positively correlated with both clinical stage and tumor progression (both P<0.001). At 6 to 8 weeks after IMRT, 19(2.3%) patients positive for plasma EBV DNA obtained the worst prognosis and 14 cases had tumor progression. At 6-8 weeks after IMRT, 9 patients were negative for EBV DNA and 3 cases had tumor progression. The tumor progression rate of patients with undetectable plasma EBV DNA at the end of IMRT was only 8.3%(64/772), and the progression-free survival rate significantly differed among three groups (all P<0.05). The sensitivity, specificity and accuracy rates of persistent positive plasma EBV DNA during follow-up were calculated as 77.6%, 100% and 98.1%, respectively. Conclusions The level of plasma EBV DNA in patients with NPC is correlated with tumor bearing and tumor progression prior to IMRT. At 6-8 weeks after IMRT, patients who are persistently positive for EBV DNA obtain the worst prognosis and should be given with appropriate adjuvant therapy. The correlation between persistent positive plasma EBV DNA during follow up and tumor progression yields a high accuracy rate, indicating that plasma EBV DNA is a reliable biomarker for monitoring the clinical efficacy after radical treatment for NPC patients.

Objective To report the spontaneous remission and induced remission of phospholipase A2 receptor (PLA2R)-associated idiopathic membranous nephropathy (IMN) in adults,as well as to explore the potential prognostic factors.Methods A total of 120 patients with IMN in Huashan Hospital during 2012 and 2017 were enrolled and their clinical data were collected.Results PLA2R-associated IMN patients accounted for 89.2％ of the IMN patients.Spontaneous remission occurred in 35.5％ of PLA2R-associated IMN patients.The patients with higher serum albumin and lower level of PLA2R antibody were more likely to achieve spontaneous remission (both P ＜ 0.05).Multivariate logistic regression analysis showed that male was an independent risk factor for spontaneous remission in PLA2R-associated IMN patients (OR=0.060,95％CI 0.007-0.493,P=0.009),while higher serum albumin at baseline (OR=1.480,95％ CI 1.144-1.932,P=0.004) and the improvement of serum albumin after 3 months' non-immunosuppressive treatment (OR=2.040,95％CI 1.322-3.151,P=0.001) were independent protective factors for spontaneous remission.About 42.1％ PLA2R-associated IMN patients had received immunosuppressive therapy,with induced remission rate being 70.7％.High serum albumin before treatment was an independent protective factor for induced remission (OR=1.268,95％ CI 1.014-1.585,P=0.038).Conclusions PLA2R-associated IMN accounts for most of the IMN patients,with a spontaneous remission rate of 35.5％,during the follow-up period,which is even higher in patients with higher baseline serum albumin and lower PLA2R antibody titer.Induced remission rate is 70.7％ in patients in need of immunosuppresants.The serum albumin level may be helpful in predicting spontaneous remission and response to immunosuppressive therapy.

Orthotopic liver transplantation (OLT) was first implemented by Starzl in 1963.With the development of liver transplantation,Tzaris was the first to report piggyback liver transplantation (PBLT) in 1989.The fundamental difference between OLT and PBLT:end to end vascular anastomosis between the donor and recipient is performed after diseased liver resection with the posthepatic inferior vena cava in OLT,while PBLT is to preserve the recipient's hepatic vein and end to end vascular anastomosis between interior vena cava of donor and shaped hepatic vein is performed.However in the clinical practice,the above two techniques cannot meet the needs of clinical liver transplantation technology.Since 1993 the author has implemented a series of improvements in liver transplantation technology based on PBLT and performed ameliorated piggyback liver transplantation (APBLT).This article focuses on the technical characteristics and clinical application of APBLT.

Objective To investigate the predictive value of dynamic changes of interferon-inducible protein-10 (IP-10) expression in the peripheral blood mononuclear cells and the model for end-stage 1iver disease (MELD) scores for short-term mortality in hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) patients .Methods Eighty patients with HBV-ACLF admitted to the Affiliated Hospital of Hubei College of Arts and Sciences from October 2013 to August 2015 were selected .During 3 months of follow-up ,33 patients died and 47 survived .The expression level of IP-10 and MELD score of two groups were measured at admission and week 1 and week 2 after treatment .The means between two groups were compared .Accuracy of predicting short-term mortality was performed by area under receiver operating characteristic curve (AUC) .Multivariate logistic regression analysis and Kaplan-Meier survival curve were used to analyze the effect of IP-10 expression and MELD score on the mortality of HBV-ACLF patients . Results The expressions of IP-10 at admission and at week 1 and 2 after treatment in the death group were 1 .095 ± 0 .202 ,1 .071 ± 0 .181 ,and 1 .078 ± 0 .198 ,respectively ,those in the survival group were 0 .894 ± 0 .181 ,0 .770 ± 0 .153 ,and 0 .732 ± 0 .137 ,respectively ,which were significantly different (t =4 .66 ,8 .02 and 9 .27 ,respectively ,all P < 0 .01) .The MELD scores at admission and at week 1 and 2 after treatment in the death group were 26 .70 ± 5 .50 ,27 .39 ± 6 .24 ,and 28 .64 ± 6 .44 ,respectively , those in the survival group were 23 .89 ± 4 .41 ,21 .57 ± 4 .68 ,and 18 .87 ± 3 .92 ,respectively ,which were significantly different (t= 2 .53 ,4 .77 and 8 .42 ,respectively ,all P< 0 .01) .Analysis of variance showed that the MELD score and IP-10 expression in the survival group at admission were significantly higher than those at week 1 and week 2 after treatment (F= 13 .464 and 15 .711 ,respectively ,both P< 0 .01) ,while there were no significant differences in the death group (F = 0 .129 and 0 .864 ,respectively ,both P >0 .05) .The AUC of IP-10 at week 2 after treatment was 0 .935 ,that of MELD score was 0 .903 (Z =0 .788 ,P= 0 .045) ,while there was no significant difference of AUC between week 1 and week 2 (0 .935 vs 0 .909 ,Z = 0 .640 ,P> 0 .05) .In addition ,the AUC of IP-10 level at week 1 and MELD score at week 2 after treatment showed no significant difference (0 .909 vs 0 .903 ,Z = 0 .133 , P > 0 .05) .Logistic multivariate regression analysis showed that IP-10 ≥ 0 .902 at week 1 ,MELD ≥ 22 .5 and IP-10 ≥ 0 .846 at week 2 were independent risk factors for death (OR= 11 .29 ,6 .60 ,and 15 .27 ,respectively ;95％ CI =1 .06 - 119 .74 ,1 .27 - 34 .26 ,and 1 .39 - 167 .62 ,respectively ;all P< 0 .05) .Conclusion The dynamic monitor of both IP-10 levels and MELD scores may have greater value in predicting prognosis of patients with HBV-ACLF .

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.