ObjectiveTo observe the clinical efficacy and safety of hot ironing with Haitongpi Formula （海桐皮方， HF） in the treatment of lumbar disc herniation （LDH） of cold-dampness obstruction type. MethodsA total of 70 patients with cold-dampness obstruction type LDH were randomly divided into a treatment group and a control group， with 35 cases in each group. Both groups received three movements technique of Qinggong Spinal Manipulation （QSM） as the basis for treatment. In addition， the treatment group received hot ironing with HF， while the control group applied Diclofenac Sodium Gel externally. The treatment duration for both groups was 14 days. The clinical efficacy was compared between groups. Japanese Orthopedic Association （JOA） score， visual analog scale （VAS） for pain， pain pressure threshold （PPT） for lumbar positive response points， and traditional Chinese medicine （TCM） symptom scores were compared， on day 7， and day 14 of treatment， as well as on day 7 and day 14 of follow-up. The lumbar curvature index （LCI） was also compared before treatment and on day 14 of treatment. Adverse reactions during the study were recorded for both groups. ResultsA total of 35 patients in the treatment group and 34 patients in the control group were included for final analysis. The clinical total effective rate of the treatment group （91.43%， 32/35） was significantly higher than that of the control group （82.35%， 28/34， P＜0.05）. Both the JOA score and PPT of the two groups increased on day 7 and day 14 of treatment， and on day 7 and day 14 of follow-up. VAS scores and TCM symptom scores both decreased. The LCI of both groups increased on day 14 of treatment （P＜0.01）. Compared with the control group at the same time points， on day 14 of treatment and day 7 and day 14 of follow-up， the treatment group had higher JOA scores and PPT， and lower VAS scores and TCM symptom scores. The LCI of the treatment group increased on day 14 of treatment （P＜0.05 or P＜0.01）. One case in the control group showed mild skin allergy， with no other adverse reactions observed in either group. ConclusionBased on three movements technique of QSM， hot ironing with HF shows better clinical efficacy than external Diclofenac Sodium Gel in the treatment of cold-dampness obstruction type LDH. It can significantly reduce lumbar pain， increase pain pressure threshold， improve clinical symptoms， lumbar function， and lumbar curvature， with good safety.

Background Pneumoconiosis is a prevalent and severely harmful occupational disease in China. Objective To estimate disease burden and trends of different types of pneumoconiosis among Chinese males from 1992 to 2021, and to provide insights for pneumoconiosis prevention and control as well as the development of public health policies in China. Methods Based on the latest data from the Global Burden of Disease (GBD) study (2021), this study evaluated the disease burden of pneumoconiosis among Chinese males using indicators such as mortality rate and disability-adjusted life years (DALYs). Joinpoint regression model and age-period-cohort model were applied to analyze trends in the mortality rates of pneumoconiosis among Chinese males. Results From 1992 to 2021, the age-standardized DALYs rate, age-standardized years of life lost (YLLs) rate, age-standardized years lived with disability (YLDs) rate, and age-standardized mortality rate of pneumoconiosis among Chinese men all showed a downward trend, with average annual percentage changes (AAPC) of −2.63%, −2.81%, −0.87%, and −2.56%, respectively (P<0.05). Among the four types of pneumoconiosis, the disease burden of silicosis was the highest. The age-standardized mortality rates for silicosis, asbestosis, coal worker’s pneumoconiosis, and other types of pneumoconiosis had AAPC of −2.18%, −1.24%, −3.81%, and −3.21% (P<0.05), respectively. The age effects showed mortality rates for all types increased with age, particularly in silicosis and coal worker’s pneumoconiosis. The period effects showed a general decline in mortality risk, though silicosis remained significantly higher than other types. The cohort effects indicated that later birth cohorts had progressively lower mortality risks. Conclusion From 1992 to 2021, the burden of pneumoconiosis among Chinese males has shownsome alleviation; however, pneumoconiosis remains China’s most severe occupational disease. Given that males are the primary affected group in both incidence and mortality, continued attention and targeted preventive measures are essential. Effective control strategies should be tailored to address the specific characteristics of each type of pneumoconiosis.

Objective:To investigate clinical curative effect of multiple composite tissues replantation with microsurgical technique in single hand.Methods:From May 2008 to December 2021, the clinical data of patients who underwent multiple composite tissue replantation in single hand in Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences and Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, were retrospectively analyzed. According to the severed site, anatomical level, the injury cause, the severity of injury, the size of severed tissue, and replantation conditions (such as blood vessels for anastomosis), the severed tissue was evaluated and carried out modified classification (type Ⅰ-Ⅳ) before the operation, and the surgical plan was designed. The severed composite tissue was debrided in emergency, the severed bone and muscle tissue were fixed, and the arteries, veins and nerves were anastomosed by microsurgical technique under a high-power microscope. The ratio of arteries to veins was 1∶1-1∶2. If enough arteries and veins could not be found, arteriovenous shunt could be used to form arterial venous flap or venous arterialized flap, or form artery flap by just artery anastomosis, or form venous flap by just vein anastomosis. Then skin tissue was sutured after recanalization. After the operation, the patients received specialized treatment and guided rehabilitation exercise. The wound healing of hand, skin color, skin quality, swelling degree, sensation, pain degree of joint, and activity function were followed up after the operation. At the last follow-up, the patient’s self-evaluation of the treatment effect was divided into three levels: satisfactory, average, and unsatisfactory. One chief physician and one doctor-in-charge were responsible for the comprehensive evaluation of curative effect, according to the assessment standard for upper limb function issued by Chinese Medical Association of Hand Surgery. 80-100 points were excellent, 60-79 points were good, 40-59 points were fair, and <40 points were poor.Results:A total of 94 severed composite tissues in 35 patients, including of 20 male patients and 15 female patients were enrolled. The average age was 36.4 years (range, 16-65 years). Fifty severed tissues in 18 cases were classified into type Ⅰ, 40 severed tissues in 15 cases type Ⅱ, 4 severed tissues in 2 cases type Ⅲ. Among the 35 cases, 1 case of thumb pulp severed tissue was necrotic at the edge (0.3 cm×0.5 cm) due to local contusion, 1 case of index finger lateral severed tissue was necrotic at the edge (0.3 cm×0.8 cm) due to local avulsion injury, and healed after dressing change, and the other replanted composite tissue survived. The patients were followed up for 3 to 65 months (average, 18.5 months). The wounds were completely healed, and the color, elasticity, and quality of the replanted tissue was close to the surrounding normal skin. There was no obvious swelling or atrophy deformity of the hands. According to the patients’ self-assessment, 31 cases were satisfied and 4 cases were average. Comprehensive evaluation of hand function and appearance: excellent in 23 cases, good in 9 cases, fair in 3 cases, excellent and good rate was about 91.4% (32/35).Conclusion:Though multiple composite tissues replantation with microsurgical technique in single hand is difficult, and vascular anastomosis technical requirement is high, once surgery succeeds, the function and appearance can get good recovery, and patient satisfaction is also relatively high.

Objective:To investigate clinical curative effect of multiple composite tissues replantation with microsurgical technique in single hand.Methods:From May 2008 to December 2021, the clinical data of patients who underwent multiple composite tissue replantation in single hand in Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences and Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, were retrospectively analyzed. According to the severed site, anatomical level, the injury cause, the severity of injury, the size of severed tissue, and replantation conditions (such as blood vessels for anastomosis), the severed tissue was evaluated and carried out modified classification (type Ⅰ-Ⅳ) before the operation, and the surgical plan was designed. The severed composite tissue was debrided in emergency, the severed bone and muscle tissue were fixed, and the arteries, veins and nerves were anastomosed by microsurgical technique under a high-power microscope. The ratio of arteries to veins was 1∶1-1∶2. If enough arteries and veins could not be found, arteriovenous shunt could be used to form arterial venous flap or venous arterialized flap, or form artery flap by just artery anastomosis, or form venous flap by just vein anastomosis. Then skin tissue was sutured after recanalization. After the operation, the patients received specialized treatment and guided rehabilitation exercise. The wound healing of hand, skin color, skin quality, swelling degree, sensation, pain degree of joint, and activity function were followed up after the operation. At the last follow-up, the patient’s self-evaluation of the treatment effect was divided into three levels: satisfactory, average, and unsatisfactory. One chief physician and one doctor-in-charge were responsible for the comprehensive evaluation of curative effect, according to the assessment standard for upper limb function issued by Chinese Medical Association of Hand Surgery. 80-100 points were excellent, 60-79 points were good, 40-59 points were fair, and <40 points were poor.Results:A total of 94 severed composite tissues in 35 patients, including of 20 male patients and 15 female patients were enrolled. The average age was 36.4 years (range, 16-65 years). Fifty severed tissues in 18 cases were classified into type Ⅰ, 40 severed tissues in 15 cases type Ⅱ, 4 severed tissues in 2 cases type Ⅲ. Among the 35 cases, 1 case of thumb pulp severed tissue was necrotic at the edge (0.3 cm×0.5 cm) due to local contusion, 1 case of index finger lateral severed tissue was necrotic at the edge (0.3 cm×0.8 cm) due to local avulsion injury, and healed after dressing change, and the other replanted composite tissue survived. The patients were followed up for 3 to 65 months (average, 18.5 months). The wounds were completely healed, and the color, elasticity, and quality of the replanted tissue was close to the surrounding normal skin. There was no obvious swelling or atrophy deformity of the hands. According to the patients’ self-assessment, 31 cases were satisfied and 4 cases were average. Comprehensive evaluation of hand function and appearance: excellent in 23 cases, good in 9 cases, fair in 3 cases, excellent and good rate was about 91.4% (32/35).Conclusion:Though multiple composite tissues replantation with microsurgical technique in single hand is difficult, and vascular anastomosis technical requirement is high, once surgery succeeds, the function and appearance can get good recovery, and patient satisfaction is also relatively high.

Objective To investigate the causal relationship between walking pace(WP)with interver-tebral disc degeneration(IVDD)and low back pain(LBP)by using two-sample Mendelian randomisation(MR)analysis method.Methods A genome-wide association study database of WP,IVDD and LBP was ob-tained,and single nucleotide polymorphisms(SNP)strongly associated with exposure were obtained as the in-strumental variables.The two confounders of smoking and sedentary were conservatively removed,and the MR analyses were performed by inverse variance weighting(IVW),weighted median,and MR-Egger methods to assess the causal relationship between WP with IVDD and LBP.The consistency and accuracy of results were ensured by heterogeneity,diversity tests,MR-PRESSO and negative control.Results The I VW results showed a significant negative correlation between WP and IVDD(OR=0.348,95％CI:0.183-0.661,P=0.001)and vice versa(OR=0.972,95％CI:0.953-0.992,P=0.007).Meanwhile there was also a significant negative correlation between WP and LBP(OR=0.214,95％CI:0.119-0.385,P＜0.001),but no causal re-lationship was found between LBP and WP.Conclusion Faster WP could effectively prevent the occurrence of IVDD and LBP,and IVDD may contribute to the occurrence of slow walking.

Panax ginseng(PG)and Panax notoginseng(PN)are highly valuable Chinese medicines(CM).Although both CMs have similar active constituents,their clinical applications are clearly different.Over the past decade,RNA sequencing(RNA-seq)analysis has been employed to investigate the molecular mechanisms of extracts or monomers.However,owing to the limited number of samples in standard RNA-seq,few studies have systematically compared the effects of PG and PN spanning multiple conditions at the transcriptomic level.Here,we developed an approach that simultaneously profiles transcriptome changes for multiplexed samples using RNA-seq(TCM-seq),a high-throughput,low-cost workflow to molecularly evaluate CM perturbations.A species-mixing experiment was conducted to illustrate the accuracy of sample multiplexing in TCM-seq.Transcriptomes from repeated samples were used to verify the robustness of TCM-seq.We then focused on the primary active components,Panax notoginseng sa-ponins(PNS)and Panax ginseng saponins(PGS)extracted from PN and PG,respectively.We also char-acterized the transcriptome changes of 10 cell lines,treated with four different doses of PNS and PGS,using TCM-seq to compare the differences in their perturbing effects on genes,functional pathways,gene modules,and molecular networks.The results of transcriptional data analysis showed that the tran-scriptional patterns of various cell lines were significantly distinct.PGS exhibited a stronger regulatory effect on genes involved in cardiovascular disease,whereas PNS resulted in a greater coagulation effect on vascular endothelial cells.This study proposes a paradigm to comprehensively explore the differences in mechanisms of action between CMs based on transcriptome readouts.

Objective:To evaluate the feasibility and safety of a novel transjugular intrahepatic portosystemic shunt (TIPS) puncture set for transjugular intrahepatic portal puncture in swine.Methods:Thirteen domestic swine were randomly divided into experimental group ( n=7) and control group ( n=6) and received transjugular intrahepatic portal puncture with the novel puncture set and the R?sch-Uchida Transjugular Liver Access Set (RUPS-100), respectively. Three swines in each group were randomly selected and sacrificed immediately after the procedure and the rest were sacrificed 1 week later. The intraoperative technical success rate, puncture attempts, procedure time, fluoroscopy time, vital signs and occurrence of complications related to the procedure as well as the changes of liver and kidney function before, immediately after and 1 week after the procedure were compared between two groups. Independent sample t test, paired t test, Mann-Whitney U test, chi-square test or Fisher′s exact test were performed to compare the differences between groups. Results:The technical success rate was 100% for both groups. No significant difference in portal puncture attempts [2.0 (1.0, 5.0) vs. 2.0(1.0, 5.5), P>0.999], procedure time [(47.7±20.6) vs. (52.5±28.0)min, P=0.729] and fluoroscopy time [(725.1±489.2) vs. (763.7±562.4)s, P=0.897] was observed between two groups. In addition, no significant difference of the major liver and kidney function between two groups before, immediately after and 1 week after procedure ( P>0.05 at all time points). No significant difference of the major liver and kidney function change in two groups during perioperative period was identified (all P>0.05). Furthermore, no significant difference of non-target puncture occurrence was observed between two groups ( P>0.999). In the meantime, no significant difference of occurrence of small hematomas around hepatic hilar was discovered among swine sacrificed immediately after procedure between two groups ( P>0.999). No other major complications were identified in either group. Conclusion:The novel TIPS puncture set is feasible and safe to perform transjugular intrahepatic portal puncture in swine.

Objective:To investigate the clinical efficacy of robot-assisted minimally invasive sacroiliac screw fixation combined with LC-II external fixation in the treatment of pelvic fracture.Methods:A retrospective analysis was conducted on 28 cases with pelvic fractures treated with robot-assisted minimally invasive sacroiliac screw fixation combined with LC-II external fixation from May 2018 to November 2022. There were 19 males and 9 females, with an average age of 43.4±16.9 years (range, 14-74 years). There was 1 case of B1 type, 1 case of B2 type, 4 cases of B3 type, 10 cases of C1 type, 9 cases of C2 type and 3 cases of C3 type by Tile classification. All the cases were treated with closed reduction, LC-II external fixation for the anterior lesions and robot-assisted minimally invasive sacroiliac screw fixation for the posterior lesions. The operation time, fluoroscopy time and excellent rate of screw placement were recorded. The quality of fracture reduction was evaluated by Matta's criteria, and the clinical effect was evaluated by Majeed score.Results:All the 28 cases successfully underwent the surgery. In 11 cases the fractures were reduced by the pelvic unlocking closed reduction device while in the other 17 cases manual reduction was applied. In this cohort, 43 screws were implanted. All the screw positions reached level I by Gras grading. The average fluoroscopy time was 16.3±5.2 s (range, 9-31 s) per screw. The average operation time was 154.9±54.7 min (range, 55-226 min). According to the Matta's criteria, the reduction was rated as excellent in 19 cases, good in 7 cases, fair in 2 cases, yielding an excellent or good rate of 93% (26/28). No iatrogenic neurovascular injury was found in all the 28 patients. The average follow-up was 18.3±7.3 months (range, 4-31 months). The fractures healed at 3.6±1.1 months (range, 2-6 months) after the surgeries. At the final follow-up, the results of the Majeed scores were rated as excellent in 13 cases, good in 11 cases, fair in 3 cases and poor in 1 case, with an excellent or good rate of 86% (24/28).Conclusion:The technique of robot-assisted minimally invasive sacroiliac screw fixation combined with LC-II external fixation used in the treatment of pelvic fracture showed good clinical results.

Objective To investigate the safety and efficacy of photodynamic therapy (PDT) for malignant obstruction of the biliary tract. Methods We retrospectively analyzed the clinical data of patients with malignant biliary obstruction treated by PDT in our medical center. On the basis of different treatment plans, the patients were categorized into the photodynamic only group and the combined treatment group, in which additional interventional operations, targeted therapy, or immunotherapy were arranged. The alterations in liver function, duration of biliary patency, and postoperative complications that occurred within one month were closely monitored in both groups. Results A total number of 19 patients were enrolled in this study. The technical success rate of PDT was 100%. The deterioration of liver function was not observed in any patients within one month after PDT. Within a maximum of 17.7 months follow-up, the patency rates of the biliary tract were 100.0%, 89.5%, 72%, and 64% at 1, 3, 6, and 12 months after the procedure, respectively. The mean biliary patency time was 6.9±0.8 months (95%CI: 5.2-8.7 months). Specifically, the biliary patency times for Bismuth type Ⅲ and Ⅳ were 7.5±1.1 and 6.1±1.3 months, respectively. The biliary patency time was around 3.3±0.7 months in the photodynamic only group and 7.9±0.9 months in the combined treatment group (P=0.017). Conclusion PDT for Bismuth Ⅲ-Ⅳ malignant biliary obstruction is safe and effective. Moreover, the period of biliary patency is greatly extended when PDT is combined with systemic therapy.

Objective:To explore the treatment method and clinical effect of chronic diabetic wounds of lower limbs in elderly patients with comorbidities.Methods:The clinical data of elderly comorbid patients with chronic diabetic wounds of lower limbs admitted to Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences from December 2019 to November 2022 were retrospectively analyzed. Multidisciplinary consultation and comprehensive evaluation were conducted for the patient before surgery and the indicators related to the underlying disease were also adjusted to the safe range for surgery. The wound secretions were taken in time for bacterial culture and drug sensitivity test, and the wound was treated with dressing change and other standardized treatments. According to the location, shape, size and depth of the lower limb wound defect, as well as the infection degree, duration of infection, and extent of surrounding skin damage, debridement, vacuum sealing drainage, tension-reduced suture, skin or flap transplantation, limb (toe) amputation and other method were selected for treatment. After surgery, the prevention and control of the comorbidities of the elderly and nursing management were continued, and the wound healing was observed. According to the evaluation criteria of flap swelling at grade 4 (increased from grade Ⅰ to grade Ⅳ), the swelling degree of the lower leg and dorsum of the foot was evaluated in the early stage (3 to 12 weeks) and the later stage (13 to 52 weeks). At the last follow-up, according to the evaluation criteria of the ankle joint wound repair, the curative effect was comprehensively evaluated (excellent, good, general, poor), and the satisfaction evaluation (satisfied, general, unsatisfied) was also conducted.Results:A total of 85 patients were included, of which 41 were males and 44 were females; the age ranged from 65 to 93 years, with a mean of 71.4 years. Comorbidities of the elderly include hypertension, coronary heart disease, cerebrovascular accident, renal insufficiency, diabetes, tumor, gout, senile dementia, senile neurasthenia, sleep disorders, malnutrition, epilepsy, urinary incontinence, delirium, depression, etc. The wound duration ranged from 6 months to 15 years. The depth of the wound reached muscle or bone, and the defect area ranged form 3.5 cm×2.5 cm to 22.0 cm×10.5 cm. All 85 patients had positive bacterial cultures of wound secretions. Drug sensitivity test results: 72 cases were sensitive, 10 cases were intermediate, and 3 cases were completely resistant. Clinical medication was based on the drug sensitivity test result and the principles of antibiotic use. For the 3 resistant cases, nutrition, support and other treatments to enhance immunity were given, and the local wound was dressed with 0.45%-0.55% iodophor. Among the 85 cases, 65 were treated with vacuum sealing drainage, 10 patients were treated with tension-reduced suture, 19 were treated with full-thickness skin graft, and 21 were treated with local flap transfer, 20 were repaired by perforator pedicle flap, and 15 underwent amputation (toe). The follow-up period was 6 to 36 months, with an average of 12.5 months. Wound healed by primary intention in 57 cases; delayed healing in 21 cases, wound healed after dressing change or surgical repair; wound not healed in 7 cases, wound completely healed after amputation (toe) or other surgical treatment. Evaluation of the degree of swelling in the lower leg and dorsum of the foot: 18 cases of grade Ⅰ, 47 cases of grade Ⅱ, 15 cases of grade Ⅲ, and 5 cases of grade Ⅳ in the early stage; 62 cases of grade Ⅰ, 18 cases of grade Ⅱ, and 5 cases of grade Ⅲ in the later stage. Comprehensive evaluation of the therapeutic effect: 23 cases were excellent, 45 cases were good, 16 cases were general, and 1 case was poor, with an excellent-good rate of 80%. Satisfaction evaluation: 78 cases were satisfied, 7 cases were general, and the satisfaction rate was 91.8%.Conclusion:Generalist clinical thinking and multidisciplinary collaborative model are important strategies for treating chronic diabetic wounds of lower limbs in elderly patients with comorbidities. By controlling infection with antibiotics and dressing changes, and using reconstructive surgery techniques to repair the wound, the wound healing rate can be improved and satisfactory treatment outcomes can be achieved.