To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

BACKGROUND:Accurate reduction of ankle fractures under direct vision has become a common understanding among foot and ankle surgeons.How to fully expose free or compressed fragments of the posterior ankle remains one of the most challenging problems. OBJECTIVE:To explore the clinical efficiency of the para-Achilles tendon approach in exposing and repositioning the posterior malleolus sandwich fracture. METHODS:A retrospective study was made for 26 patients with posterior malleolus sandwich fracture treated with open reduction and internal fixation via para-Achilles tendon approach from January to December 2020 in The Second People's Hospital of Dalian.21 of 26 cases were managed with the lateral approach of Achilles tendon and 5 cases were managed with the medial approach of Achilles tendon.There were 19 males and 7 females,with the age of 24-69 years,averagely 38.6 years.The operation time and postoperative complications were recorded.The fracture reduction condition was evaluated by Burwell-Charnley imaging standard.Before operation,3 months after operation and last follow-up,visual analog scale score,ankle plantar flexion and dorsiflexion and American Orthopedic Foot&Ankle Society Ankle Hind Score were used to evaluate the treatment effect. RESULTS AND CONCLUSION:(1)All 26 patients were followed up for an average of 14.6 months(range 13-18 months).The operation time was 52-85 minutes(average 64.2 minutes).(2)Part of the skin edge of the lateral malleolus incision was necrotic in one patient and healed completely after a dressing change.Incision healing of the other patients was in one stage.(3)Through Burwell-Charnley imaging standard,anatomical reductions were obtained in 24 of 26,and good reductions were in 2 of 26,with an excellent and good rate of 100%.(4)At the last follow-up,the visual analog scale score(1.19±0.40)was significantly lower than the preoperative score(6.81±0.80)(P<0.01).Ankle plantar flexion(33.5±5.02)° and ankle plantar back stretch(17.23±0.99)° were significantly increased compared with preoperative data(14.58±2.50)° and(5.81±1.02)°(P<0.01).American Orthopedic Foot&Ankle Society Ankle Hind Score was improved to(89.31±3.62)points compared to preoperative(46.00±5.45)points(P<0.01).The results were excellent in 23 patients and good in 3 patients,with an excellent and good rate of 100%.(5)It is concluded that the open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fracture were efficient with decreased operation time,satisfying fracture reduction,fewer complications,satisfactory motion range,and functional recovery.

Objective To establish and validate a Nomogram model for predicting the overall survival(OS)of the patients with intrahepatic cholangiocarcinoma(ICC)based on domestic multicenter data,and screen the beneficiaries of adjuvant chemotherapy based on the prediction model.Methods From December 2011 to December 2017,the data of 278 patients with postoperative pathological diagnosis of ICC from 4 medical centers in our country were collected retrospectively COX regression model was used to screen the independent risk factors of OS and constructed a Nomogram model.This model was used to stratify the risk of OS for all patients and to screen the beneficiaries of adjuvant chemotherapy.Results A total of 278 patients were enrolled,and 23 cases(8.3%)received adjuvant chemotherapy.COX multivariate analysis showed that drinking history,ECOG score,method of hepatectomy,lymph node status,number of tumors,and tumor differentiation were independent risk factors for postoperative OS.The Nomogram model had a C-index of 0.690(95%CI:0.646-0.734)in the training cohort and 0.740(95%CI:0.863-0.617)in the validation cohort.According to risk stratification by Nomogram model,in the high-risk group there was a statistically significant difference in survival between adjuvant chemotherapy and non-adjuvant chemotherapy(P=0.033),whereas in the low-risk group,there was no significant difference in survival(P=0.59).Conclusions Nomogram model based on independent risk factors of OS demonstrated excellent predictive capability for survival and could be used to screen,and identify the patients with ICC who benefit from adjuvant chemotherapy.

Objective Through the study of different grades for Atractylodis macrocephalae Rhizoma decoction pieces,improve the quality evaluation method,and provide theoretical basis for the classification of Atractylodis macrocephalae Rhizoma.Methods According to the traditional classification,the Atractylodis macrocephalae Rhizoma decoction pieces was divided into three grades.By HPLC and UV method,the determination of atractylodes lactone Ⅰ,Ⅱ,Ⅲ and the content of total polysaccharide for 36 batches of different grades of Atractylodis macrocephalae Rhizoma decoction pieces.According to the 2020 edition of Chinese pharmacopoeia,the correlation between the appearance traits of different grades of Atractylodis macrocephalae Rhizoma decoction pieces and the internal quality control indexes was analyzed.Results According to the appearance characters,multiple quality control index of content determination,through the principal component analysis,cluster analysis and so forth.The quality of first-grade decoction pieces of Atractylodis macrocephalae Rhizoma is significantly better than the second-grade and third-grade decoction pieces(P<0.05),and there is no significant difference between second-grade and third-grade decoction pieces(P>0.05).As a result,the Atractylodis macrocephalae Rhizoma decoction pieces can be divided into two grades,different grades with the content of atractylodes lactone and total polysaccharide were positively correlated.Conclusion The classification of Atractylodis macrocephalae Rhizoma decoction pieces based on multiple quality control indexes combined with appearance characters can provide a scientific basis for the quality control and grade study of this decoction piece.

Objective:To study the effects of cathepsin K(CTSK)on the healing process of tooth extraction socket and type H blood vessel angiogenesis in mice.Methods:Ctsk knockout(Ctsk-/-)mice were generated by CRISPR/Cas9 technology,and genotype sequen-cing,general observation,Micro-CT and immunohistochemistry were performed to confirm successful knockout of Ctsk.Then 8 week-old WT and Ctsk-/-mice were used to establish the tooth extraction modle by extracting the left maxillary first molars,and the mice were sac-rificed at the day 7,10,14,21,28 and 35 respectively(n=3)after tooth extraction.Then samples were subjected to stereo microscope and Micro-CT examination.Immunofluorescence staining was used to study the effect of Ctsk knockout on type H blood vessel angiogene-sis.Results:Ctsk knockout did not affect the soft tissue healing of tooth extraction socket,but significantly promoted the bone healing process,and Ctsk deficency significantly enhanced type H blood vessel angiogenesis in the tooth extraction socket.Conclusion:Ctsk knockout can enhance type H vessel angiogenesis,and promote bone healing process of tooth extraction socket in mice.

Objective:To investigate the prevention and risk factors of deep vein thrombosis (DVT) in the lower extremity after medial open wedge high tibial osteotomy (HTO).Methods:A total of 128 patients who underwent medial open wedge HTO in the Third Hospital of Hebei Medical University from January 2020 to October 2022 were retrospectively analyzed, including 45 males and 83 females, aged 59.3±6.8 years (range, 44-87 years). Postoperative anticoagulation with enoxaparin sodium was applied at a randomized dose of 4,000 AXaIU/d or 6,000 AXaIU/d. Gender, age, history of chronic diseases (hypertension, diabetes), smoking history, body mass index, and body fat percentage were collected. On admission, the risk of DVT was assessed using the Caprini scale and calf circumference was measured. Hemoglobin, D-dimer, antithrombin III, activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), fibrinogen degradation products (FDP), glutathione, glutathione, urea, creatinine, uric acid were recorded. Patients were divided into DVT group and non-DVT group according to whether DVT occurred after operation. Binary logistic regression was used to analyze the independent risk factors of DVT after HTO. The receiver operating characteristic (ROC) curve was plotted, and the area under curve (AUC) was calculated to analyze the predictive value of the postoperative Caprini scale in the occurrence of DVT after HTO.Results:A total of 128 patients were enrolled, 83 patients were treated with enoxaparin sodium 4 000 AXaIU/d and 45 patients were treated with enoxaparin sodium 6 000 AXaIU/d. According to the results of color Doppler examination of bilateral lower extremity veins on the third day after operation, DVT occurred in 39% (50/128) of patients, including 39 cases of calf intermuscular thrombosis, 6 cases of peroneal vein thrombosis, 4 cases of posterior tibial vein thrombosis, and 1 case of popliteal vein thrombosis. DVT occurred in 36% (30/83) of patients receiving 4 000 AXaIU/d enoxaparin sodium and 44% (20/45) of patients receiving 6 000 AXaIU/d enoxaparin sodium, with no statistically significant difference (χ 2=0.84, P=0.358). Univariate analysis showed that smoking history, postoperative Caprini scale≥8, and female may be associated with the development of DVT after HTO ( P<0.05). They were included in the binary logistic regression, and the results showed that postoperative Caprini scale≥8 was an independent risk factor for DVT after HTO. The ROC curve of postoperative Caprini scale for predicting DVT after HTO was drawn, and the AUC was 0.847 (95% CI: 0.73, 0.96), the optimal cut-off value was 8, and the sensitivity and specificity were 84.2% and 77.6%, respectively. Conclusion:Caprini scale≥8 is an independent risk factor for DVT after medial open wedge HTO. Caprini scale has a good value in predicting the occurrence of DVT after HTO. The recommended dose of enoxaparin sodium is 4 000 AXaIU/d for the prevention of postoperative DVT, and increasing the dose is not associated with a decreased risk of DVT.

Objective:To analyze the effectiveness and safety of the second course radiotherapy for unresectable colorectal cancer liver metastases.Methods:We retrospectively collected the data of 28 patients with unresectable colorectal cancer liver metastases who received the second course radiotherapy at Peking University Cancer Hospital and Institute from 2017 to 2023, to analyze the feasibility of re-irradiation.Results:For the 28 patients, the median follow-up time after re-irradiation was 20.2 months. The median time interval between the first- and second-course radiotherapy was 11.1 months. The median biologically effective doses of the first- and second-course radiotherapy were 100 Gy and 96 Gy, respectively. Stereotactic body radiotherapy was administered to 25 patients (89.3%) during the first course and 24 patients (85.7%) during the second course of radiotherapy. The mean equivalent dose in 2 Gy fractions to the normal liver was 10.1 Gy in the first-course radiotherapy and 7.9 Gy in the second-course radiotherapy. The complete response rate, partial response rate, and objective response rate after re-irradiation were 54.5%, 18.2%, and 72.7%, respectively. After re-irradiation, the 2-year cumulative local failure rate was 17.0% when calculated based on patients and 15.1% when calculated based on lesions, the 1-year progression-free survival rate was 27.4%, and the 3-year overall survival rate was 46.7%. The second-course radiotherapy was well tolerated, with most patients (75.0%) experiencing grade 1-2 acute adverse reactions and only one case (3.6%) experiencing grade 3 acute adverse events.Conclusions:Second course radiotherapy is an effective and safe treatment approach for selected patients with unresectable colorectal cancer liver metastases.

Objective:To evaluate the clinical outcomes of Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy in the treatment of talus osteochondral lesions with autologous osteochondral transplantation (AOT).Methods:From January 2017 to December 2019, Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy were performed in the AOT treatment of 11 patients with talus osteochondral lesions. They were 9 men 2 women, with a mean age of 32. 6 years (range, from 22 to 45 years). Their lesions were all Hepple type V. Their American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), International Knee Documentation Committee Knee Evaluation Form (IKDC) score, and imaging data were measured pre- and post-operatively for assessment of clinical outcomes.Results:All the patients were followed up for 13 to 24 months (average, 15.6 months). Their AOFAS (94.3±2.9) and VAS (1.2±0.4) scores at the final follow-up were significantly improved compared with the pre-operative values (49.5±6.6 and 5.7±1.2) ( P<0.05). There was no significant difference between their pre- and post-operative IKDC scores for the ipsilateral knee joint ( P>0.05). The imaging showed that the talus cystic change disappeared and the grafted bone was fully fused with the talus with no abnormal change in the joint space. Conclusion:In the AOT treatment of talus osteochondral lesions, Chaput tuberosity osteotomy and lateral malleolus sagittal osteotomy can obviously relieve ankle pain and improve ankle function.

Objective:To investigate the associations of articular depression depth (ADD) and tibial plateau widening (TPW) by pre-operative CT measurement with incidence of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture.Methods:Included in this retrospective study were 131 patients who had been admitted to Emergency Center of Trauma, The Third Hospital Affiliated to Hebei Medical University from January 2016 to January 2020 for Schatzker type Ⅱtibial plateau fractures. They were 88 males and 51 females, aged from 18 to 60 years (average, 41.5 years), with 74 right and 57 left sides injured. All patients were treated with closed reduction and internal fixation assisted by bidirectional traction. Arthroscopy was used to detect the status of lateral meniscus immediately after closed reduction and internal fixation of the fracture fragments. Furthermore, patients were divided into 2 groups according to the integrity of lateral meniscus: meniscal tear group ( n=70) and tear-free group ( n=61). The 2 groups were compared in terms of age, gender, body mass index(BMI), injury side, time interval from injury to surgery, TPW and ADD. The receiver operating curve (ROC) was drafted to calculate the cut-off values of TPW and ADD in complication of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture. Results:The overall incidence of lateral meniscal tear in this cohort was 53.4% (70/131). There was no statistically significant difference in terms of age, gender, injury side, BMI or time interval from injury to surgery between the 2 groups ( P>0.05); TPW and ADD were significantly higher in the meniscal tear group than in the tear-free group ( P<0.05). To predict lateral meniscal tear in patients with Schatzker type Ⅱtibial plateau fracture, the area under ROC was 0.656 (95% CI: 0.562 to 0.750, P=0.002) for TPW and 0.709 (95% CI: 0.619 to 0.800, P<0.001) for ADD, respectively; the cut-off values of TPW and ADD were 4.3 mm and 6.1 mm. Conclusion:TPW and ADD may be effective predictors for prediction of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture.

Objective:To evaluate our self-designed easily-breaking compression bone bolt plus bone plate in the treatment of tibial plateau fracture.Methods:From July 2018 to December 2018, 12 patients with tibial plateau fracture were treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University using our self-designed easily-breaking compression bone bolt plus bone plate. They were 8 males and 4 females, aged from 20 to 65 years (average, 45.6 years), with 6 left sides and 6 right sides injured. According to Schatzker classification, there were one case of type I, 3 cases of type Ⅱ, 3 cases of type Ⅲ, 2 cases of type Ⅳ, one case of type Ⅴ and 2 cases of type Ⅵ. The width of tibial plateau was measured and compared before and after operation on X-ray films. Operation time, blood loss and fracture union time were recorded. Loss of reduction and postoperative complications were followed up. Knee function was evaluated at the final follow-up by Rasmussen scoring.Results:For this cohort, operation time averaged 54.6 min, blood loss 25 mL, and fracture union time 17.2 weeks. No nonunion or delayed union was observed. The postoperative width of tibial plateau was (78.9±7.2) mm, significantly narrower than the preoperative value [(87.4±6.1) mm] ( P < 0.05). No loss of reduction or surgical complications occurred postoperation. Deep venous thrombosis of the lower extremity developed in 2 patients but recovered after treatment. The Rasmussen scoring for knee joint function at the final follow-up yielded 9 excellent, 2 good and one poor. Conclusion:In treatment of tibial plateau fractures, our self-designed easily-breaking compression bone bolt plus bone plate can restore width of tibial plateau, compress fracture fragments tightly and allow for early exercise, leading to fine functional recovery of the knee joint.