Objective The Nuangong Waifu formula （NGWFF） is a traditional Chinese medicine prescription that has been used in gynecology of traditional Chinese medicine in our hospital for many years. It has a certain effect on preventing postoperative intrauterine re-adhesion. To further retrospectively analyze the clinical efficacy of NGWFF. Methods A total of 200 patients who were diagnosed with intrauterine adhesions and underwent intrauterine adhesion separation from January 2018 to December 2020 were retrospectively included. They were divided into control group and observation group according to different drug use for postoperative prevention of re-adhesion, with 100 cases in each group. All patients were given oral estrogen and progesterone （ethinyl estradiol tablets 0.037 5 mg, q12 h, or estradiol valerate tablets 3 mg, q12 h, a total of 21 days, 7 days after estrogen therapy plus dydrogesterone 20 mg, qd or progesterone capsules 200 mg, qd） to promote endometrial growth. In the control group, 100 patients only used estrogen and progesterone after operation. In the observation group, 100 patients were treated with NGWFF at Guanyuan acupoint （four fingers under the navel）, once a day. Both groups were evaluated for the degree of intrauterine adhesions under hysteroscopy and the effective rate after 3-5 menstrual cycles of drug treatment. Results Compared with using estrogen and progesterone alone, combination use of NGWFF significantly decreased in the scores of intrauterine adhesions under hysteroscopy （2.41±1.19 vs 3.31±1.18, P=0.00）, and the effective rate was also significantly higher than that in the control group （ 86 % vs 47 %, P<0.000）. Conclusion The combination use of NGWFF was more effective than using estrogen and progesterone alone in preventing re-adhesion after intrauterine adhesions， which provided a scientific basis for the clinical application of NGWFF.

Objective To investigate the effect of mirror therapy on upper limb function and cortical activity in patients with type I complex regional pain syndrome(CRPS)after stroke. Methods A total of 72 post-stroke patients with type I CRPS were recruited at the Third Rehabilitation Hospital Affiliat-ed to Shanghai University of Traditional Chinese Medicine from October,2017 to February,2022.They were ran-domly divided into control group(n=36)and mirror therapy group(n=36).The control group received conven-tional rehabilitation training,while the mirror therapy group received mirror therapy in addition.Before treat-ment,as well as at three and six weeks after treatment,they were evaluated using the Visual Analog Scale(VAS)for pain,modified Barthel Index(MBI),edema volume and Brunnstrom stage.Resting-state data were collected for 440 seconds using a 32-channel functional near-infrared spectroscopy(fNIRS)system. Results After treatment,VAS scores significantly improved in each group,showing better after six weeks than after three weeks(P<0.01).The mirror therapy group was better than the control group after six weeks(P<0.05).MBI scores also significantly improved in each group,showing better after six weeks than after three weeks(P<0.001).Edema volume significantly decreased in each group(Z>30.113,P<0.001),while the mirror therapy group was better than the control group after six weeks(Z=-3.347,P=0.001).Edema volume in the mirror therapy group significantly reduced at both three and six weeks(Z<-0.667,P<0.01),with a stronger effect ob-served after six weeks(Z=-0.667,P=0.005).Brunnstrom stages improved significantly in each group(Z>29.714,P<0.001),while the mirror therapy group was better than the control group after six weeks(Z=-2.046,P=0.041).After treatment,the control group showed strong connectivity between right M1 and right primary so-matosensory cortex,while the mirror therapy group demonstrated stronger connectivity between left M1 and right M1,right primary somatosensory cortex,right pre-motor and supplementary motor cortex.Connectivity be-tween left and right primary somatosensory cortex increased in mirror therapy group,as well as the connectivity between left pre-motor-supplementary motor cortex and right M1,right pre-motor-supplementary motor cortex and left primary somatosensory cortex,left M1 and left primary somatosensory cortex,and left primary somato-sensory cortex and right M1(∣t∣>3.402,P<0.01). Conclusion Mirror therapy may relieve pain and edema,and improve upper limb motor function in post-stroke patients with type I CRPS,which may associate with stonger connectivity between sensory regions on the unaffected side and sensory-motor regions on the affected side,promoting sensorimotor cortical reorganization.

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.

Objective To systematically retrieve relevant research on the application of exercise intervention dur-ing hematopoietic stem cell transplantation for hospitalized children at home and abroad,to generalize and summa-rize the content of exercise intervention,the effect of intervention,and safety monitoring,with the purpose of provid-ing reference bases for the clinical application of exercise intervention in the future.Methods In accordance with the scoping review framework,we systematically retrieved databases including Web of Science,PubMed,Scopus,Cochrane Library,Embase,CINAHL,CNKI,VIP Database,Wanfang Data and China Biomedical Literature Database,with a retrieval timeframe from database establishment to May 19,2023.Based on the criteria for inclusion and ex-clusion of literature,we screened,summarized,extracted,and analyzed the literature.Results A total of 17 pieces of literature were included,including 5 randomized controlled trials,9 quasi-experimental studies,and 3 mixed-method studies.There were 4 categories of exercise including aerobic,anti-gravity,resistance,and stretching;most of the ex-ercises were of low to moderate intensity;the exercise interventions had a positive impact on muscle strength,quali-ty of life,cardiorespiratory function,body composition,and hematological indices;the safety monitoring consisted of red blood cell,hemoglobin,and platelet counts,temperature,joint and muscle pains,as well as falls,and syringe shedding.Conclusion The application of exercise intervention is safe and feasible,with a positive effect on chil-dren with hematopoietic stem cell transplantation in muscle strength,quality of life.Medical staff should combine with the clinical situation to formulate a reasonable and unified exercise program and to carry out scientific and standardized exercise management.

A 31-year-old man sought medical evaluation for a 2-year history of edema and proteinuria, with prior pathology suggesting atypical membranous nephropathy (MN). Despite treatment with a combination of steroids, calcineurin inhibitors, and four courses of rituximab (1 g, intravenous injection), the patient′s nephrotic syndrome showed no relief (24 h urine protein peaked at 31.18 g/d), indicating refractory nephrotic syndrome. Later in the disease course, a sudden surge of creatinine level (322.5 μmol/L) prompted a renal biopsy, which revealed concurrent acute interstitial nephritis. Further treatment involving steroids, cyclophosphamide, and a fifth rituximab infusion (1 g, intravenous injection) resulted in improvement in renal function (serum creatinine: 322.5?147 μmol/L), but the MN failed to achieve partial relief. Subsequent treatment with the novel humanized CD20 monoclonal antibody obinutuzumab (1 g, intravenous injection) was initiated. In the latest follow-up, anti-phospholipase-A2-receptor antibody (PLA2R) antibody were negative, B cells were eliminated, serum albumin was 36 g/L, urine protein-to-creatinine ratio was 4 810 mg/g, and serum creatinine was 162 μmol/L. This case underscores the potential efficacy of obinutuzumab in refractory MN. For advanced MN cases, prompt identification of the cause of acute kidney injury is crucial, emphasizing the need for targeted interventions to potentially stall renal function decline.

Objective:To explore the mechanism of exacerbating chronic graft versus host disease (GVHD) in mice with inflammatory status and enhancing immune injury in mice with PD-1.Method:Bone marrow and spleen cells of DBA/2 mice were injected into BALB/C mice pretreated with chemotherapy regimen (Flu+Bu) for constructing a chronic GVHD model. The animals were assigned into two groups of zymosan (100M SPL+10M BM+Zymosan) and control (100M SPL+10M BM+ PBS). After transplantation, two groups of mice were observed for weight changes, survival status and chronic GVHD manifestations. Target organ tissues were harvested for pathological scoring. Flow cytometry was employed for detecting cell subpopulations and surface co-stimulatory molecules in target organs. PD-1 monoclonal antibody was injected into inflammatory murine model. Mice were observed and target organ cells were harvested for subsets and co-stimulatory factors.Result:In in vivo experiments, zymosan group showed more significant changes of chronic GVHD with higher mortality rate, faster weight loss and more severe symptoms of GVHD. At Week 2 post-transplantation, hematoxylin-eosin stain of target organ tissue was performed for pathology examination. Zymosan group showed more lymphocyte infiltration, more severe inflammation and more significant tissue injury with higher GVHD pathological score. The proportion of M2 in liver/lung of zymosan group was significantly lower than that of control group ( P<0.05) and no significant difference existed in the proportion of M1. In in vivo experiments, M1 ratio of splenic cell spiked markedly in zymosan group as compared to control group while M2 ratio declined greatly. The secretions of IL-4 and IL-10 dropped significantly while co-stimulatory molecules CD80 and CD86 rose obviously. Conclusion:The worsening graft-versus-host disease in inflammatory mice with anti-PD1 treatment is associated with a decline of Treg proportion.

Objective:To investigate the effect of cumulative serum uric acid (cumSUA) on early-onset ischemic stroke in young adults.Methods:A prospective cohort study was conducted. A total of 15 607 Kailuan workers who participated in at least two physical check-ups in 2006 and 2008 and at the time of the last physical check-up before 2014 were selected as subjects. Cumulative uric acid exposure during the follow-up period was calculated. The subjects were divided into three groups according to the quantile of cumSUA: the first quantile group was cumSUA<1 563 μmol/L·year, the second quantile group was: 1 563 μmol/L·year≤cumSUA<1 996 μmol/L·year, the third group was cumSUA≥1 996 μmol/L·year. The time of the last physical check-up was regarded as the starting point of follow-up, and early-onset ischemic stroke was regarded as the end event. Kaplan-Meier was used to calculate the incidence of early-onset ischemic stroke in different groups, and Log-rank method was used to calculate the differences in the incidence of early-onset ischemic stroke among different groups. Multivariate Cox regression model was used to analyze the risk of early-onset ischemic stroke in different groups. A four-node (5th, 25th, 75th, 95th percentile) restricted cubic spline plot was used to assess the dose-response relationship between cumSUA and early-onset ischemic stroke.Results:A total of 15 607 subjects were followed up for (7.3±1.1) years. 100 cases with early-onset ischemic stroke were observed with an average age of (46±4) years old. The number of events in the first, second, and third quartile groups was 18, 35, and 47, respectively, and the cumulative incidence rates in the first, second, and third quartile groups were 0.40%, 0.77%, and 1.07%, respectively. The difference in cumulative incidence of endpoint events between the groups was statistically significant by Log-rank test ( χ2=14.96, P=0.003). The results of Cox regression analysis showed that after correcting for confounders, the HR(95% CI) for early-onset ischemic stroke in the second and third quartile groups was [1.67(0.92,3.00), P=0.090; 2.05(1.48,3.69), P=0.020]. Restricted cubic spline results showed a nonlinear correlation between cumSUA and early-onset ischemic stroke after adjysted for confounders. Conclusion:Cumulative serum uric acid is positively correlated with the risk of early-onset ischemic stroke in young adults.

ObjectiveTo establish the characteristic sugar spectrum of polysaccharides， oligosaccharides and monosaccharides of wild-simulated and transplanted Astragali Radix， and find out the difference of the sugar spectrum between the two， so as to provide a basis for quality evaluation of Astragali Radix. MethodThe relative molecular weight distribution of polysaccharides from 18 batches of wild-simulated Astragali Radix and 12 batches of transplanted Astragali Radix were characterized by high performance liquid chromatography-evaporative light scattering detection（HPLC-ELSD） to establish the characteristic chromatograms of two kinds of polysaccharides. The difference in the peak area ratio of APS-Ⅱ， a polysaccharide component with a relative molecular weight of 10 kDa， in two kinds of Astragali Radix was analyzed， and the critical value of peak area ratio of APS-Ⅱ was determined by receiver operating characteristic（ROC） curve. At the same time， APS-Ⅱ was partially acid-hydrolyzed by trifluoroacetic acid（TFA） to establish characteristic spectra of two kinds of oligosaccharides from Astragali Radix based on HPLC-ELSD， and the characteristics of differential oligosaccharides were found by principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）. Two kinds of APS-Ⅱ were completely acid-hydrolyzed by TFA and derivatized to establish characteristic spectra of two kinds of monosaccharides from Astragali Radix based on HPLC， PCA and OPLS-DA were performed on the peak area ratio of two kinds of monosaccharides to explore the differences in the composition of two kinds of APS-Ⅱ monosaccharides. ResultThe characteristic sugar spectrum of polysaccharides from Astragali Radix showed that the peak area ratio of APS-Ⅱ was the main difference， and the peak area of APS-Ⅱ of wild-simulated and transplanted Astragali Radix were 89.17%-97.17% and 80.14%-91.96%， respectively. The ROC curve determined the critical value of 92.28% for the difference of APS-Ⅱ peak area ratio of the two kinds of Astragali Radix. The multivariate analysis of APS-Ⅱ oligosaccharides revealed that the peak area ratio of oligosaccharides with polymerization degree≥10 was the main difference， which ranged from 11.835%-19.092% for wild-simulated products and 2.778%-7.017% for transplanted products. The results of monosaccharide characteristic sugar spectrum analysis showed that both Astragali Radix species consisted of six monosaccharides， and glucose and arabinose were the differential monosaccharide fractions. The peak area ratios of glucose and arabinose in wild-simulated products were 85%-93.9% and 2.7%-5.8%， respectively， while those of transplanted products were 74.3%-87.3% and 5.3%-10.7%， suggesting that the structures of the two polysaccharide fractions APS-Ⅱ of Astragali Radix may be different. ConclusionThe difference of sugar spectrum between two kinds of Astragali Radix may be related to the content and structure of APS-Ⅱ， and this study may provide a reference for the study of carbohydrates in Astragali Radix and the quality evaluation of medicinal materials.

Primary biliary cirrhosis/cholangitis is an autoimmune disease. Renal tubular acidosis is a common form in PBC cases, but Fanconi syndrome is rarely reported. The paper reported a 66-year-old female patient with fatigue, renal insufficiency and elevated bile duct enzymes. The patient presented with type 2 proximal renal tubular acidosis and complete Fanconi syndrome. Laboratory examinations showed high-titer-positive anti-mitochondrial antibodies, elevated serum IgM, and type 3 cryoglobulinemia. Renal biopsy revealed interstitial nephritis, and electron micrographs showed abnormal mitochondria in proximal tubular epithelial cells. The patient's renal function ameliorated, and acid-base imbalance and electrolyte disturbances were corrected after high-dose glucocorticoid treatment.

In order to meet the needs of contemporary society for medicine and cultivate high-quality compound medical talents, Chongqing Medical University has carried out the "organ system-centered" urogenital system integration curriculum reform. In the practice of integrated curriculum teaching, students have deepened their systematic understanding of medical knowledge, enhanced their enthusiasm and initiative in classroom learning, cultivated students' logical thinking ability, and improved students' innovative scientific research ability, by reorganizing the curriculum system, rewriting textbooks, improving the teaching environment, forming a teaching team, and reforming teaching methods, which laids the foundation for the further improvement of the medical curriculum.