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To evaluate the diagnostic performance of targeted next-generation sequencing (tNGS) for tuberculosis (TB) in patients with human immunodeficiency virus (HIV) and to compare it with traditional diagnostic methods. A total of 66 HIV patients were enrolled, including 25 with confirmed TB infection and 41 without TB. Statistical analyses were performed using SPSS 22.0. Diagnostic performance was assessed using the chi-square test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Kappa coefficient, and the area under the curve (AUC) of the receiver operating characteristic curve (ROC) were calculated for tNGS. McNemar's chi-square test was used to compare the diagnostic efficacy of tNGS with other methods. The sensitivity, specificity, PPV, NPV, AUC, and Kappa of tNGS were 76.00%, 100.00%, 100.00%, 87.20%, 0.880, and 0.797 respectively, all superior to traditional methods. When combined with Xpert, the sensitivity increased to 84.00%, and the AUC improved to 0.920, indicating strong diagnostic complementarity. tNGS exhibits high sensitivity and specificity for diagnosing TB in patients with HIV. Notably, the combination of tNGS with Xpert further enhances diagnostic efficacy, underscoring its potential clinical promotion value.

Background: Sea buckthorn (SBT) is a traditional Chinese medicine (TCM), rich in calcium, phosphorus, and vitamins, which can potentially prevent and treat osteoporosis. However, no research has been conducted to confirm these hypotheses. QiangGuYin (QGY) is a TCM compound used to treat osteoporosis. There is a need to investigate whether SBT enhances QGY efficacy. Objectives: The aim of this study was to explore whether SBT enhances QGY efficacy by inhibiting CKIP-1 and Notum expression through the Wnt/β-catenin pathway. The study also aimed to explore the active components of SBT. Methods: Experimental animals were divided into control, model, QGY, SBT, SBT + Eucommia ulmoides (EU), and SBT + QGY groups. After treatment, bone morphometric parameters, such as estrogen, PINP, and S-CTX levels, and Notum, CKIP-1, and β-catenin expression were examined. Screening of SBT active components was conducted by molecular docking to obtain small molecules that bind Notum and CKIP-1. Results: The results showed that all the drug groups could elevate the estrogen, PINP, and S-CTX levels, improve femoral bone morphometric parameters, inhibit Notum and CKIP-1 expression, and promote β-catenin expression. The effect of SBT + EU and SBT + QGY was superior to the others. Molecular docking identified that SBT contains seven small molecules (folic acid, rhein, quercetin, kaempferol, mandenol, isorhamnetin, and ent-epicatechin) with potential effects on CKIP-1 and Notum. Conclusion: SBT improves bone morphometric performance in PMOP rats by inhibiting CKIP-1 and Notum expression, increasing estrogen levels, and activating the Wnt/β-catenin signaling pathway. Furthermore, SBT enhances the properties of QGY. Folic acid, rhein, quercetin, kaempferol, mandenol, isorhamnetin, and ent-epicatechin are the most likely active ingredients of SBT. These results provide insight into the pharmacological mechanisms of SBT in treating osteoporosis.

Objective To evaluate the clinical efficacy of internal fixation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. Methods A search was conducted in PubMed, Web of Science, Embase, and Cochrane Library databases up to April 2020. The present study compared internal fixation and hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. RevMan5.3 software provided by the International Cochrane Group was used for the meta‐analysis. To compare the differences in the operation time, intraoperative bleeding, length of hospital stay, superficial infection, Harris hip score, mortality within 1 year, mortality within 2 years, reoperation, incidence of deep venous thrombosis (DVT), partial weight‐bearing time, non‐union, and implant‐related complications between an internal fixation group and an hemiarthroplasty group. Results A total of 1300 patients were included in nine studies. The results showed that the operation time (MD = −18.09, 95% CI: −27.85–−8.34, P = 0.0003), intraoperative bleeding (MD = −195.31, 95% CI: −244.8–−147.74, P < 0.0001), implant‐related complications (MD = 3.83, 95% CI: 1.74–8.45, P = 0.0008), and partial weight‐bearing time (MD = 17.21, 95% CI: 1.63–32.79, P = 0.03) have statistical significance. However, there is not statistical significance for the Harris hip joint function scale (HHS) (MD = 5.60, 95% CI: −1.13–12.33, P = 0.10), DVT (MD = 1.02, 95% CI: 0.45–2.27, P = 0.97), length of hospital stay (MD = ‐1.08, 95% CI: −2.82–0.66, P = 0.22), superficial Infection (OR = 0.92, 95% CI: 0.43–1.98, P = 0.89), mortality within 1 year (OR = 0.95, 95% CI: 0.61–1.48, P = 0.81), mortality within 2 years (OR = 0.93, 95% CI: 0.61–1.43, P = 0.75), reoperation (MD = 1.80, 95% CI: 0.64–5.04, P = 0.26), and non‐union (OR = 1.20, 95% CI: 0.48–3.03, P = 0.70). The result of the subgroup analysis showed no significant differences between the less than 2 years follow‐up and the 2 years or more follow‐up group. The only difference was for the Harris hip score: the internal fixation group was superior to the hemiarthroplasty group in the less than 2 years subgroup analysis, while there was no difference between the internal fixation group hemiarthroplasty group in the 2 years or more subgroup analysis. Conclusion Compared with the internal fixation group, those in the hemiarthroplasty group could carry out weight‐bearing training early and implant‐related complications were reduced, but it requires longer operation time and there is greater intraoperative blood loss. There is no difference in mortality, the incidence of DVT, non‐union, HHS, reoperation, length of hospital stay, and superficial infection. Hemiarthroplasty may be a better choice for unstable intertrochanteric fractures in the elderly.

Introduction. The aim of this study was to investigate the efficacy of herbal formula QiangGuYin (QGY) in postmenopausal women. Materials and Methods. A total of 240 participants from six clinical centers were randomly to receive alendronate 70 mg/week, QGY granules 20 g/day, and placebo. Primary end points were BMD changes over 6 and 12 months; secondary end points were bone turnover markers changes at 3, 6, 9, and 12 months. Safety was monitored by clinical adverse events reported during the follow-up. Results. Of 240 women recruited, 218 completed the study. Significant BMD increases from baseline were observed over 6 and 12 months at each observed part both in QGY and alendronate compared with placebo (p<0.01). Alendronate-treated subjects had significant decreases in β-CTX compared to QGY-treated subjects at each time point assessed (p<0.01). Reduction in t-P1NP was only observed in the QGY group at 3 and 6 months (−23.81% and −3.07%, resp.). No significant difference was observed in the overall incidence of clinical adverse events among the alendronate group and the QGY group (5.0% versus 7.5%, p=0.513). Conclusion. 1-Year treatment with QGY demonstrated a safe statistical increase in BMD and new balance may be rebuilt after 9 months. This trail is registered with ChiCTR-POC-16008026.

This study aims to develop and validate a clinical-radiomics fusion model that integrates clinical characteristics with CT-derived radiomic features for the rapid and accurate prediction of drug resistance in patients with cavitary pulmonary tuberculosis (TB). A total of 231 patients with microbiologically confirmed cavitary pulmonary TB were retrospectively enrolled and divided into a drug-resistant TB group (n=89) and a drug-sensitive TB group (n=142) based on drug susceptibility testing. Radiomics features were extracted from CT images, and a radiomic signature was constructed following stability assessment, dimensionality reduction, and least absolute shrinkage and LASSO regression. Clinical predictors with significant statistical differences were identified. Independent clinical, radiomic, and combined clinical-radiomics fusion models (nomogram) were developed using eight machine learning algorithms, and their performances were compared. Models' performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Four clinical variables (C-reactive protein, diabetes history, alanine aminotransferase, and blood calcium levels) and a radiomics signature comprising 14 key features were selected as final predictors. The fusion model achieved AUCs of 0.861 in the training set and 0.884 in the test set, outperforming both the standalone clinical and radiomic models. Decision curve analysis demonstrated that the fusion model provided higher clinical net benefit across a wide range of threshold probabilities. The proposed clinical-radiomics fusion model enables accurate prediction of drug resistance in cavitary pulmonary TB, supporting the optimization of initial treatment strategies and promoting the implementation of precision medicine in TB management.

Objective To observe the effect of zoledronic acid on the reduction of acute bone loss and fracture rate in elderly postoperative patients with intertrochanteric fracture. Methods From August 2012 to January 2015, a total of 482 patients with senile osteoporotic femoral intertrochanteric fracture, who accepted proximal femoral intramedullary fixation under anesthesia were analysed. The patients were divided into two groups. Treatment group (353 cases) were treated with 100 mL/5 mg of zoledronic acid injection in 1 week after operation, as well as orally taken 600 mg/d of calcium carbonate and active vitamin D3 400 IU/d. Control group (129 cases) were given the same dose of calcium carbonate and active vitamin D3 orally. Efficacy evaluation were conducted during different periods of medication Results Compared with pre‐medication, indexes of bone metabolism (TARP‐5b, CTX) in the treatment group were brought down, especially significantly statistically different after 12 months of medication. The treatment group performed superior to control group in alleviating the pain of back and posture changing (P < 0.05), improving bone density (P < 0.05), depressing re‐fracture rate (P < 0.01) after 24 months of medication. In addition, BP, PF and MH dimension scores were demonstrated with statistical significance (P < 0.05). Conclusions The application of zoledronic acidin elderly postoperative patients with intertrochanteric fracture can not only relieve acute bone loss, reduce the incidence rate of re‐fracture, alleviate osteoporosis pain and the pain from osteoporotic fracture, but also improve bone metabolism and quality of life, which may offer an acceptable clinical opinion

Kidney transplant recipients are at high risk for tuberculosis (TB), particularly drug-resistant forms, due to prolonged immunosuppressive therapy. The diagnosis and treatment of TB in this population pose unique challenges, including infection control, graft protection, and drug interactions. We report the case of a 28-year-old male kidney transplant recipient was diagnosed with pulmonary TB four months post-transplantation. The patient self-discontinued initial anti-TB therapy after one month, leading to relapse nine months later, with confirmed rifampicin resistant. Following three months of treatment with a second-line regimen including linezolid, he developed disseminated skeletal TB, with drug susceptibility testing indicating linezolid resistance. The treatment was adjusted to an all-oral regimen including isoniazid, moxifloxacin, clofazimine, cycloserine, and bedaquiline, resulting in significant clinical and radiological improvement. In the present case, the patient's non-adherence to the medication regimen resulted in initial treatment failure. Against the backdrop of immunosuppression, rifampicin resistance emerged rapidly. Although the subsequent linezolid-containing regimen was administered for a short duration, it likely triggered ribosomal target mutations-leading to linezolid resistance and hematogenous dissemination to the bone-driven by both drug selection pressure and the history of irregular treatment. Confronted with dual resistance and disseminated disease, the therapeutic strategy pivoted to a bedaquiline-based regimen. This shift highlights the clinical management art of finely balancing treatment efficacy with the risk of rejection through the optimized adjustment of immunosuppressants guided by therapeutic drug monitoring. The management of drug-resistant tuberculosis in kidney transplant recipients necessitates a flexible and comprehensive strategy. This encompasses early clinical suspicion, the prompt performance of molecular and phenotypic drug susceptibility testing to guide therapeutic decisions, rigorous management of treatment adherence, and the real-time adjustment of therapeutic regimens based on evolving resistance profiles and clinical responses. Multidisciplinary collaboration is essential for balancing anti-tuberculosis efficacy with graft survival. Although novel agents such as bedaquiline offer promising options for salvage therapy, their administration in transplant recipients requires intensified monitoring for drug-drug interactions and adverse events.

Congenital pain insensitivity is a rare genetic disease and its clinical manifestations are many. In orthopaedics, common complications of this disease include painless fracture and Charcot's arthropathy. We followed up a case of multiple fractures of the lower extremity in two years, during which time he came to the clinic for five painless fractures of the lower extremity in a total of six parts. A mutation was found on the NTKRI gene (chr1:156813923(hg19), NM_001007792.1: c.1221938C > T). We have developed a combination of surgery and conservative treatments for his condition, focusing on the mental state of the child and considering comprehensive treatment to be the best option for this type of patient. Occult fractures caused by pain insensitivity are often treated only as fractures, however their complications require routine examination and cleaning, suitable protective shoes, splint fixation, stretching, guided exercise planning, and early treatment of injuries. Due to the risk of fracture in the future, it is important that parents pay attention to the behavior and psychology of the child, such as not letting the child participate in exercise with a risk of injury, protective measures while playing, engaging in psychological counseling, and inducing interest in mental activity. These interventions will play a very important role in preventing the recurrence of fracture.

To evaluate the clinical value of targeted next-generation sequencing (tNGS) using bronchoalveolar lavage fluid (BALF) in diagnosing pulmonary tuberculosis (PTB) and detecting resistance to first-line anti-tuberculosis drugs, and to compare its performance with traditional methods. In this study, BALF samples were collected from 258 patients with suspected PTB and subjected to AFB staining, mycobacterial solid culture, TB-DNA PCR, Xpert MTB/RIF, and tNGS. Using comprehensive clinical diagnosis or phenotypic DST as the reference, we evaluated the sensitivity, specificity, and other metrics of each method and assessed tNGS performance in detecting resistance to rifampicin, isoniazid, streptomycin, and ethambutol. Overall, tNGS achieved a sensitivity of 91.10%, specificity of 89.70%, and an AUC of 0.904, all significantly higher than traditional methods. It uniquely identified 24 positive cases missed by other methods. In smear-negative patients, sensitivity remained high at 88.10%, with an AUC of 0.891. For drug-resistance detection, tNGS showed the best performance in judging isoniazid resistance (sensitivity 83.10%, specificity 90.30%), and also showed high negative predictive values for rifampicin, streptomycin, and ethambutol (all > 94%). tNGS provides excellent diagnostic accuracy for PTB and reliable detection of drug-resistant mutations from BALF samples. It is particularly suitable for smear-negative cases and for resistance screening, making it a powerful complement to the existing TB diagnosis system with high clinical application potential.

Neutrophil extracellular traps (NETs) represent a response mechanism in which activated neutrophils release DNA-based webs, adorned with histones and neutrophil proteases, to capture and eliminate invasive microorganisms. However, when these neutrophils become excessively activated, much more proteases associated with NETs are liberated into surrounding tissues or bloodstreams, thereby altering the cellular milieu and causing tissue damage. Recent research has revealed that NETs may play significant roles in the emergence and progression of various diseases, spanning from infections, inflammation to autoimmune disorders and cancers. In this review, we delve deeply into the intricate and complex mechanisms that underlie the formation of NETs and their profound interplay with various clinical pathologies. We aim to describe the application perspectives of NETs related proteins in specific disease diagnosis and treatment.