People's Hospital of Cangzhou

This study aimed to compare radiographic accuracy, perioperative parameters, and early clinical outcomes between computer-assisted navigation total knee arthroplasty (TKA) and conventional TKA. This retrospective single-center study included adult patients who underwent primary TKA between January 2023 and December 2024. Patients were allocated to either a navigation group or a conventional control group based on the use of a computer-assisted navigation system. All other perioperative management followed a standardized institutional protocol. Demographic characteristics, comorbidities, and preoperative functional status – including Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index – were comparable between groups. Primary outcomes included operative time, intraoperative blood loss, radiographic alignment parameters (hip–knee–ankle angle, femoral and tibial component positioning in coronal, sagittal, and rotational planes), and mechanical axis outliers. Secondary outcomes included early postoperative visual analog scale pain scores, knee range of motion at discharge, length of hospital stay, and complication and reoperation rates. A total of 159 patients were included, comprising 91 in the navigation group and 68 in the control group. Operative time was significantly longer in the navigation group, whereas intraoperative blood loss was significantly lower compared with the control group. Radiographic evaluation demonstrated that navigation TKA achieved more accurate restoration of the hip–knee–ankle angle, reduced mechanical axis outliers, and smaller deviations in femoral and tibial component alignment across coronal, sagittal, and rotational planes. Early postoperative clinical outcomes favored the navigation group, including lower visual analog scale pain scores, greater knee range of motion at discharge, and a modestly shorter hospital stay. Although prosthesis-related complications, medical complications, and reoperation rates were numerically lower in the navigation group, these differences did not reach statistical significance. Computer-assisted navigation TKA improved radiographic alignment accuracy and was associated with favorable early postoperative clinical outcomes compared with conventional TKA, albeit with longer operative time. While complication and reoperation rates were not significantly different, navigation may offer benefits in surgical precision and short-term recovery. Further prospective studies with long-term follow-up are warranted to determine its impact on implant survival and functional outcomes.

Abstract Background The high mortality of septic shock demands novel adjunctive therapies. Shenfu Injection (SFI), a traditional Chinese medicine, shows potential but its mechanism remains unclear. Methods We conducted an open-label, randomized trial in 80 patients with septic shock. Patients received standard care with or without adjunctive SFI for 7 days. The primary outcome was 28-day mortality. Key secondary outcomes included inflammatory markers, lactate clearance, and vasopressor duration. Concurrently, network pharmacology analyzed SFI’s bioactive components, predicted targets, and enriched pathways, with validation by molecular docking. Results The 28-day mortality was significantly lower in the SFI group (20.0% vs. 42.5%, P=0.030). SFI accelerated clinical improvement, evidenced by greater reductions in IL-6 and procalcitonin, higher 6-hour lactate clearance (35.2% vs. 18.5%, P<0.001), shorter vasopressor duration (48 vs. 72 hours, P<0.001), and more rapid SOFA score decline. Network pharmacology identified 145 SFI-septic shock common targets, with IL-6, SRC, and MAPK3 as central hubs. Pathway analysis revealed significant enrichment in TNF, PI3K-Akt, and IL-17 signaling pathways. Molecular docking confirmed strong binding of key SFI components (e.g., Ginsenoside Rh2) to core targets like IL-6. Conclusions Adjunctive Shenfu Injection reduces mortality and improves clinical recovery in septic shock, potentially through a multi-target mechanism involving modulation of inflammatory and cellular signaling pathways. This integrative study provides both clinical evidence and a mechanistic framework supporting SFI’s use. Clinical Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800020435.

BackgroundBreast cancer–related lymphedema (BCRL) is a common complication that impairs function and quality of life. The effectiveness of photobiomodulation (PBM) therapy remains unclear, necessitating a systematic review and meta-analysis.MethodsThis review followed the PRISMA guidelines and was registered in PROSPERO (CRD420261296197). PubMed, CENTRAL, and Embase were systematically searched for randomized controlled trials (RCTs) evaluating PBM therapy for BCRL up to January 20, 2026. Outcomes of interest included upper limb volume, circumference, grip strength, and pain. Pooled effects were synthesized using appropriate meta-analytic models and reported as mean differences with 95% confidence intervals. Risk of bias, methodological quality, and certainty of evidence were assessed using RoB 2, the PEDro scale, and GRADE, respectively.ResultsNine RCTs involving 312 participants with BCRL were included. Compared with control conditions, PBM therapy resulted in significant reductions in affected limb volume (SMD = −0.78, 95% CI −1.03 to −0.54; I² = 22%) and limb circumference (MD = −3.61 cm, 95% CI −4.85 to −2.38; I² = 44%). Functional outcomes also improved, with increased grip strength (MD = 1.72 kg, 95% CI 1.07 to 2.37; I² = 14%) and reduced pain intensity (MD = −0.29, 95% CI −0.52 to −0.05; I² = 0%). Overall risk of bias was low to moderate, with some concerns about allocation concealment; evidence certainty was mostly moderate by GRADE.ConclusionsPBM therapy is associated with significant improvements in limb volume, circumference, grip strength, and pain in patients with BCRL. Despite these favorable findings, the overall certainty of evidence is moderate, and safety conclusions are limited by sparse adverse-event reporting. Larger, well-designed RCTs are needed to confirm efficacy and optimize treatment parameters.

The influence of sex differences on the clinical prognosis of patients with non-ST-elevation myocardial infarction (NSTEMI) remains controversial. This multicenter, retrospective study analyzed NSTEMI patients from five institutions. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and major adverse cardiac events (MACE). Multivariate logistic regression was used to assess sex differences in revascularization. Multivariate Cox regression with stepwise selection identified independent prognostic predictors. Stratified analyses were performed by revascularization status. To strengthen the analytical robustness, propensity score matching (PSM) was employed as a sensitivity analysis, balancing age, comorbidities, and key treatment factors. A total of 4,911 NSTEMI patients (3,506 men; 1,405 women) completed follow-up. Women were less likely to undergo revascularization (adjusted odds ratio 0.68, 95%CI 0.58–0.79). Over a median follow-up of 527 days, women had significantly lower cumulative survival free from MACCE and MACE (both P < 0.001). After multivariate adjustment, women remained to have an increased risk of MACCE (HR 1.20, 95% CI 1.03–1.40) and MACE (HR 1.30, 95% CI 1.09–1.55) in the overall cohort, particularly among those not undergoing revascularization (MACCE: HR 1.30, 95% CI 1.05–1.60; MACE: HR 1.64, 95% CI 1.27–2.10). However, no significant sex-based differences were observed in the revascularized subgroup (P > 0.05). These findings were consistent in the PSM-based sensitivity analysis. The sex-based prognosis difference in NSTEMI is linked to underutilization of revascularization in women. Ensuring equitable guideline-directed revascularization may eliminate this disparity.

ObjectiveThis study aimed to integrate bioinformatics, network pharmacology, and single-cell sequencing to explore the potential neuro-immune mechanisms by which the traditional Chinese medicine formula Xiao-Yao-San (XYS) ameliorates chronic stress-induced colorectal cancer (CRC) progression.MethodsTranscriptomic and survival data of CRC patients were obtained from public databases (TCGA, GEO). Combined with literature review, 130 neurotransmitter-related receptor genes (NRGs) were screened, and their expression and prognostic value in CRC were analyzed. Based on 51 XYS components previously identified by UHPLC/Q-TOF-MS, network pharmacology was employed to predict their potential targets (1,228 in total). These targets were intersected with differentially expressed NRGs. Molecular docking was further performed to evaluate the binding affinity between XYS components and receptors. A mouse model of chronic unpredictable mild stress (CUMS) combined with orthotopic CRC transplantation was established. Neurotransmitter levels were measured by mass spectrometry, and 10x Genomics single-cell transcriptomic sequencing was applied to analyze changes in the tumor immune microenvironment.ResultsBioinformatics analysis revealed that 100 NRGs were significantly dysregulated in CRC tissues. After intersecting with XYS targets, 14 potential NRGs were identified, among which seven (ADRA2C, DRD1, GABRA2, HTR1B, HTR1D, HTR2A, HTR2B) showed significant correlation with patient prognosis. Molecular docking demonstrated favorable binding activity between XYS components (such as 8-Debenzoylpaeoniflorin and Sucrose) and the hub NRGs. In vivo experiments confirmed that XYS reversed CUMS-induced abnormalities in tumor and plasma levels of norepinephrine, dopamine, and serotonin. Single-cell sequencing further indicated that XYS reduced the CUMS-induced increase in myeloid-derived suppressor cell (MDSC) proportion and modulated the expression of key NRGs, including HTR2A in macrophages and HTR1B in T cells. KEGG enrichment analysis suggested that neuroactive ligand-receptor interaction and immune-related pathways were significantly regulated upon XYS intervention.ConclusionXYS modulates neurotransmitter homeostasis and the tumor immune microenvironment in CRC under chronic stress through a multi-component and multi-target manner, which is closely associated with the regulation of key NRGs such as HTR1B and DRD1. This study provides neuro-immunological evidence for the clinical application of XYS in CRC patients with emotional disorders.

The HSK16149-201/301 trial demonstrated short-term efficacy of the GABA analog crisugabalin for diabetic neuropathic pain. In the current study, patients in both the crisugabalin and placebo control groups of the HSK16149-201/301 trial were invited to receive 80 mg/day crisugabalin for an additional 52 weeks. The primary end point was safety. The secondary end point was pain control as measured using the Short-Form McGill Pain Questionnaire (SF-MPQ). A total of 301 patients (mean age 59.7 years and males 58.1%) were enrolled. The rate of treatment-related adverse events (TRAEs) was 38.9% (117/301). The most frequent TRAEs were dizziness (27.2%), somnolence (8.3%), and peripheral edema (3.0%). The rate of Grade 3 or higher TRAEs was 1.7%. TRAEs led to dose reduction in 41 patients (13.6%), treatment interruption and discontinuation each in three patients (1.0%). At week 52, the mean difference in SF-MPQ pain rating index (PRI) and visual analog scale pain score from baseline was -2.5 (95% CI -2.9 to -2.0; paired t-test p < 0.0001) and -23.4 (95% CI -25.6 to -21.2; paired t-test p < 0.0001), respectively. The proportion of patients with SF-MPQ PPI score ≤ 1 increased by 19.0% over baseline (p < 0.0001). In summary, crisugabalin at 80 mg/day was well tolerated and demonstrated sustained analgesic activities. ClinicalTrials.gov identifier: NCT05890053.

BackgroundDiabetic retinopathy (DR) is a common microvascular complication of diabetes, which seriously affected the life quality in diabetic patients. Developing novel therapy to improve DR is essential. Qinggan Mingshi granules (QGMS) have been demonstrated with protective effects on DR clinically. However, the mechanisms of QGMS remain unclear.MethodIn order to more thoroughly investigate the mechanism underlying the positive effects of QGMS on DR, a mouse model of DR was established in this study, and the positive effects of QGMS on the DR mice were observed. Next, the effects of QGMS on ferroptosis and the NRF2/GPX4 axis were investigated. In addition, we used an NRF2 inhibitor to determine whether QGMS inhibits ferroptosis in DR mice via the NRF2/GPX4 axis.ResultOur results revealed the therapeutic effects of QGMS on DR including improving the permeability of blood–retina barrier (BRB), reducing the pathological changes and ferroptosis in retina. QGMS also induced the expression of NRF2/GPX4 axis in retina. Furthermore, ML385, an NRF2 inhibitor, abolished the effects of QGMS on DR.ConclusionThis study revealed that QGMS can effectively treat DR by alleviating retinal damage through enhancing the expression of NRF2/GPX4 axis‐related proteins and thus scavenging of LPOs, ultimately reducing ferroptosis.

ObjectiveThe objective of this study is to explore the effect of bedside normobaric saturated oxygen inhalation combined with upper and lower limb rehabilitation training on diabetic lower extremity arterial disease (LEAD).MethodsFrom January 2022 to December 2023, 60 DM‐LEAD patients from the Second Hospital of Hebei Medical University were randomly divided into control (30 cases) and study (30 cases) groups. Both received standard treatment; the control group added MOTOmed‐based limb rehabilitation training, and the study group further received atmospheric saturated oxygen therapy. Pre‐ and posttreatment indices (VAS, Barthel index, blood glucose, blood lipid, inflammatory factors, ABI, TcPO2, and DPA flow velocity) were compared.ResultsBoth groups improved posttreatment (all p < 0.05), with the study group showing greater benefits (all p < 0.05): VAS decreased more (3.82 ± 0.75 vs. 2.15 ± 0.62 points), Barthel index increased more (28.67 ± 4.21 vs. 15.33 ± 3.85 points), FBG (2.35 ± 0.52 vs. 1.21 ± 0.45 mmol/L) and 2hPBG (3.12 ± 0.68 vs. 1.78 ± 0.59 mmol/L) decreased more, IL‐6 (8.76 ± 1.52 vs. 4.23 ± 1.18 pg/mL) and CRP (12.35 ± 2.18 vs. 6.12 ± 1.85 mg/L) decreased more, and ABI (0.38 ± 0.07 vs. 0.20 ± 0.06), TcPO2 (18.67 ± 3.25 vs. 9.35 ± 2.78 mmHg), and DPA flow velocity (0.18 ± 0.04 vs. 0.09 ± 0.03 m/s) increased more.ConclusionThe combined therapy improves pain and daily living abilities, delays DM‐LEAD progression, may reduce amputation risk, and improves outcomes. Long‐term effects need further study.Trial Registration: The UK′s Clinical Study Registry: ISRCTN11014449

This study aimed to develop a multivariable predictive model for early identification of infection risk in patients with acute pancreatitis (AP) complicated by systemic inflammatory response syndrome (SIRS) and to evaluate the clinical impact of a nomogram-based antibiotic decision-making pathway on prophylactic antibiotic use. We retrospectively analyzed the clinical data of 200 patients with AP and SIRS admitted between January 2024 and April 2025. Independent risk factors for infection were identified using multivariable logistic regression analysis. A predictive nomogram was constructed based on the regression coefficients, and its performance was evaluated by the area under the receiver operating characteristic curve, calibration curve, and decision curve analysis. Clinical outcomes, including antibiotic use, intensive care unit admission, 28-day mortality, and length of hospital stay, were compared between infected and non-infected patients. Multivariable analysis identified Acute Physiology and Chronic Health Evaluation II score, neutrophil-to-lymphocyte ratio, procalcitonin, C-reactive protein, and arterial partial pressure of oxygen as independent predictors of infection (P < .05 for all). The nomogram demonstrated good discrimination with an area under the receiver operating characteristic curve of 0.82 and satisfactory calibration. Decision curve analysis confirmed its superior net clinical benefit compared with traditional scoring systems and empirical treatment strategies. The infection group had significantly higher antibiotic utilization rates (100.0% vs 45.8%), intensive care unit admission rates (28.8% vs 7.5%), 28-day mortality (15.0% vs 3.3%), and longer hospital stays (18.10 ± 6.63 vs 11.83 ± 4.13 days; P < .001). The proposed nomogram provides an accurate and practical tool for early infection risk prediction in AP patients with SIRS. Implementing a nomogram-based antibiotic decision-making pathway may reduce unnecessary prophylactic antibiotic use, improve clinical decision-making, and optimize patient outcomes.