BACKGROUND:With changing lifestyles and aging,sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function.Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain.OBJECTIVE:To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging,analyze the correlation between spinal sagittal imbalance and knee joint parameters,and explore their compensatory mechanisms.METHODS:A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics,First Affiliated Hospital of Soochow University between January 1,2021 and December 31,2023 were included.Radiographic measurements were performed using whole-body EOS to determine pelvic tilt,pelvic incidence,lumbar lordosis,sagittal vertical axis,global tilt,hip-knee-angle,knee flexion angle,lateral distal femoral angle,and medial proximal tibial angle.Patients were classified into normal group(pelvic incidence-lumbar lordosis＜10°),compensated group(10°＜pelvic incidence-lumbar lordosis＜20°),and decompensated group(pelvic incidence-lumbar lordosis＞20°)based on the SRS-Schwab spinal deformity classification according to pelvic incidence-lumbar lordosis difference.The differences in radiographic parameters among the groups were analyzed.The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group.Patients were divided into chronic low back pain group and non-chronic low back pain group,patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms,and the relationship between radiographic parameter differences and clinical symptoms was analyzed.RESULTS AND CONCLUSION:(1)When pelvic incidence-lumbar lordosis was less than 20°,lateral distal femoral angle and medial proximal tibial angle tended to stabilize.When pelvic incidence-lumbar lordosis was greater than 20°,it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle,with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence-lumbar lordosis values.(2)Compared with the normal group,the compensated group had significantly increased pelvic tilt(P＜0.01),while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences;the decompensated group showed significant increases in pelvic tilt(P＜0.01),and decreases in hip-knee-angle,and knee flexion angle(P＜0.01).Compared with the compensated group,the decompensated group showed a significant decrease in hip-knee-angle(P＜0.05),but had no significant differences in pelvic tilt and knee flexion angle.(3)Compared with the non-patellofemoral pain group,patients with patellofemoral pain had significant decreases in spinal lumbar lordosis,lateral distal femoral angle,and medial proximal tibial angle(P＜0.05)and a significant increase in pelvic incidence-lumbar lordosis(P＜0.05).(4)Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group(P＜0.05).(5)Compared with the normal group,both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).Compared with the compensated group,the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).(6)Pelvic incidence-lumbar lordosis values increased with age and were higher in females compared with males.(7)This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms.Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment.Furthermore,spinal sagittal imbalance is more severe in elderly and female patients.

BACKGROUND:With changing lifestyles and aging,sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function.Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain.OBJECTIVE:To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging,analyze the correlation between spinal sagittal imbalance and knee joint parameters,and explore their compensatory mechanisms.METHODS:A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics,First Affiliated Hospital of Soochow University between January 1,2021 and December 31,2023 were included.Radiographic measurements were performed using whole-body EOS to determine pelvic tilt,pelvic incidence,lumbar lordosis,sagittal vertical axis,global tilt,hip-knee-angle,knee flexion angle,lateral distal femoral angle,and medial proximal tibial angle.Patients were classified into normal group(pelvic incidence-lumbar lordosis＜10°),compensated group(10°＜pelvic incidence-lumbar lordosis＜20°),and decompensated group(pelvic incidence-lumbar lordosis＞20°)based on the SRS-Schwab spinal deformity classification according to pelvic incidence-lumbar lordosis difference.The differences in radiographic parameters among the groups were analyzed.The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group.Patients were divided into chronic low back pain group and non-chronic low back pain group,patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms,and the relationship between radiographic parameter differences and clinical symptoms was analyzed.RESULTS AND CONCLUSION:(1)When pelvic incidence-lumbar lordosis was less than 20°,lateral distal femoral angle and medial proximal tibial angle tended to stabilize.When pelvic incidence-lumbar lordosis was greater than 20°,it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle,with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence-lumbar lordosis values.(2)Compared with the normal group,the compensated group had significantly increased pelvic tilt(P＜0.01),while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences;the decompensated group showed significant increases in pelvic tilt(P＜0.01),and decreases in hip-knee-angle,and knee flexion angle(P＜0.01).Compared with the compensated group,the decompensated group showed a significant decrease in hip-knee-angle(P＜0.05),but had no significant differences in pelvic tilt and knee flexion angle.(3)Compared with the non-patellofemoral pain group,patients with patellofemoral pain had significant decreases in spinal lumbar lordosis,lateral distal femoral angle,and medial proximal tibial angle(P＜0.05)and a significant increase in pelvic incidence-lumbar lordosis(P＜0.05).(4)Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group(P＜0.05).(5)Compared with the normal group,both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).Compared with the compensated group,the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).(6)Pelvic incidence-lumbar lordosis values increased with age and were higher in females compared with males.(7)This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms.Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment.Furthermore,spinal sagittal imbalance is more severe in elderly and female patients.

Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

Objective To investigate the effect of ankle pump exercises,based on hemodynamic mechanisms,on the prevention of venous thrombosis in stroke patients.Methods A total of 110 stroke patients,admitted to a tertiary A hospital in Jiangsu Province between June 2023 and June 2024,were selected using a convenience sampling method.The patients were divided into an experimental group and a control group,with 55 patients in each group.The experimental group received ankle pump exercise nursing interventions based on hemodynamic mechanisms,while the control group received routine nursing interventions.The incidence of lower extremity deep vein thrombosis,Pittsburgh Rehabilitation Participation Scale scores,subjective perceived fatigue,and exercise self-efficacy scores were compared between 2 groups on the 7th day of hospitalization.Results No dropouts occurred in either group.The incidence of deep vein thrombosis was significantly lower in the experimental group than it in the control group(P=0.004).The Pittsburgh Rehabilitation Participation scores on day 1,3,5,and 7 were higher in the experimental group compared to them in the control group(P＜0.001).A significant time-dependent trend was observed in Pittsburgh Rehabilitation Participation scores(P=0.034).Subjective fatigue was significantly lower in the experimental group at various time points(P＜0.001).Both groups showed an increase in exercise self-efficacy over time(P=0.016),with the experimental group demonstrating higher exercise self-efficacy than the control group on the day before discharge(P=0.003).Conclusion Ankle pump exercises,based on hemodynamic mechanisms,can effectively reduce the incidence of deep vein thrombosis in stroke patients,enhance rehabilitation participation and exercise self-efficacy,without increasing subjective fatigue.

Objective:To analyze the epidemiological characteristics of the population receiving assisted reproductive technology (ART) therapy and the health status of their offspring in Shanghai from 2011 to 2020.Methods:Based on the birth cohort of the entire population in Shanghai, the proportion and trend changes of ART offspring in the birth cohort were analyzed. The characteristics of ART and naturally conceived populations, including household registration, education level, maternal age, and reproductive history, were examined. Additionally, the health status between ART offspring and naturally conceived offspring were compared.Results:From 2011 to 2020, a total of 70 729 ART offspring were born in Shanghai, accounting for 3.69% of the total births. In 2020, this proportion reached 7.79%. The ART conception rate for primiparous women was higher than that for multiparous women, with both showing upward trends and reaching 9.87% and 2.36%, respectively, in 2020. The ART conception rate was higher in women with higher education levels and local household registration than in those with lower education levels and non-local household registration. The incidence rates of preterm birth and low birth weight in ART singleton offspring were 7.76% and 4.82%, respectively, higher than the 4.69% and 2.87% in naturally conceived offspring, but no increasing trend was observed in naturally conceived offspring. Among twin and multiple newborns, the incidence rates of preterm birth and low birth weight were 56.98% and 46.82% for ART, lower than the 58.51% and 51.32% for natural conception.Conclusions:The difference in social and demographic characteristics was obvious in population receiving ART, suggesting that the differed demand of some people for ART therapy, and it is necessary to strengthen the construction of public health services and further expand the coverage and accessibility of ART services. With technological advancements, the rates of preterm birth and low birth weight remain relatively stable, and even decrease in twin and multiple newborns.

Objective To investigate the effect of loganin(Log)on glutamine metabolism in cervical cancer through the regula-tion of nuclear factor red blood cell 2 related factor 2(NFE2L2)-ferritin heavy chain 1(FTH1)-glutathione peroxidase 4(GPX4).Methods Bioinformatics analysis was conducted to identify common targets of Log,glutamine metabolism,and cervical cancer.Hela cells were divided into Blank,control(Ctrl),Log,cisplatin(DDP),NFE2L2 activator(TBHQ),NFE2L2 inhibitor(ML385),and TBHQ+Log groups to detect cell proliferation,invasion,apoptosis,glutamine metabolism,and the protein expression of NFE2L2,FTH1,and GPX4.A cervical cancer xenograft mouse model was established to investigate the in vivo effects of Log on the progression of cervical cancer.Results Bioinformatics analysis confirmed that NFE2L2 might be a target of Log in the treatment of cervical cancer.Both Log and DDP reduced the proliferation and invasion abilities of Hela cells,increased apoptosis,and decreased the levels of glutamine and glutamic acid,as well as the protein expression of glutaminase(GLS1)and glutamic dehydrogenase(GLUD1,P<0.05).The NFE2L2 activator TBHQ had opposite effects,whereas ML385 had a similar impact on the Log.Additionally,Log treatment inhibited the protein expression of NFE2L2,FTH1,and GPX4(P<0.05).Animal experiments showed that Log significantly inhibited cervical cancer progression(P<0.05).Conclusion Log affects cervical cancer progression via glutamine metabolism by inhibiting the NFE2L2-FTH1-GPX4 signaling pathway.

Disorders of mitochondrial dynamics are closely re-lated to the development of neurodegenerative diseases(NDDs),which are characterized by the loss of neurons in brain and spinal cord cells.Diseases such as Alzheimer's disease,Parkinson's disease,Huntington's disease,and so on are in-volved in NDDs,which are often accompanied by disorders of mi-tochondrial dynamics during the development of these diseases.Recently,the researches on mitochondrial dynamics to study the pathogenesis of neurodegenerative diseases and related medica-tion innovation have garnered significant attention.This review focuses on the fundamental molecular processes of mitochondrial dynamics,such as mitochondrial transport,mitochondrial autoph-agy,and mitochondrial fission-fusion,and their molecular mecha-nisms in the pathogenesis of NDDs.It also outlines the recent research progress on Chinese materia medica and natural prod-ucts in ameliorating NDDs by modulating mitochondrial dynam-ics.The aim is to establish a foundation for researching innova-tive traditional Chinese medicine for NDDs-related diseases by focusing on mitochondrial dynamics.

Case 1,a 69-year-old male patient,was admitted to our hospital due to"dizziness,fatigue,nausea,diarrhea,and oral bleeding for 10 d",with a recent history of field farming work.The patient exhibited leukopenia,thrombocytopenia,and clinical manifestations of multi-organ dysfunction,including coagulation dysfunction,liver function abnormalities,gastrointestinal disorders,myocardial injury,and respiratory failure.Bone marrow aspiration smear revealed hemophagocytosis,and out-of-hospital testing for the severe fever with thrombocytopenia syndrome bunyavirus was positive.The patient was diagnosed with severe fever with thrombocytopenia syndrome(SFTS)complicated by hemophagocytic lymphohistiocytosis(HLH).After diagnosis,glucocorticoid combined with ribavirin treatment was initiated.However,the patient still died,which may be related to factors such as delayed medical consultation,advanced age,and poor control of viral replication.Case 2,a 73-year-old male patient,was admitted to our hospital due to"fatigue for 1 week",with a recent history of field farming work.The patient also presented with leukopenia and thrombocytopenia,combined with liver and coagulation function abnormalities.Bone marrow aspiration smear showed hemophagocytosis,and the patient was highly suspected of SFTS with HLH.We empirically initiated preemptive treatment with favipiravir for antiviral therapy,combined with glucocorticoid for anti-inflammation,to early inhibit novel bunyavirus replication and cytokine storm.Subsequent testing reported the severe fever with thrombocytopenia syndrome bunyavirus nucleic acid quantification as 2.69×103 50%tissue culture infective dose(TCID50)/mL,confirming the diagnosis of SFTS with HLH.The patient's clinical symptoms and various indicators generally improved.Review of these two similar cases suggests that early empirical preemptive use of favipiravir to control viral replication in clinical practice may improve the treatment and prognosis of patients with SFTS complicated by HLH.

Objective:To analyze the epidemiological characteristics of the population receiving assisted reproductive technology (ART) therapy and the health status of their offspring in Shanghai from 2011 to 2020.Methods:Based on the birth cohort of the entire population in Shanghai, the proportion and trend changes of ART offspring in the birth cohort were analyzed. The characteristics of ART and naturally conceived populations, including household registration, education level, maternal age, and reproductive history, were examined. Additionally, the health status between ART offspring and naturally conceived offspring were compared.Results:From 2011 to 2020, a total of 70 729 ART offspring were born in Shanghai, accounting for 3.69% of the total births. In 2020, this proportion reached 7.79%. The ART conception rate for primiparous women was higher than that for multiparous women, with both showing upward trends and reaching 9.87% and 2.36%, respectively, in 2020. The ART conception rate was higher in women with higher education levels and local household registration than in those with lower education levels and non-local household registration. The incidence rates of preterm birth and low birth weight in ART singleton offspring were 7.76% and 4.82%, respectively, higher than the 4.69% and 2.87% in naturally conceived offspring, but no increasing trend was observed in naturally conceived offspring. Among twin and multiple newborns, the incidence rates of preterm birth and low birth weight were 56.98% and 46.82% for ART, lower than the 58.51% and 51.32% for natural conception.Conclusions:The difference in social and demographic characteristics was obvious in population receiving ART, suggesting that the differed demand of some people for ART therapy, and it is necessary to strengthen the construction of public health services and further expand the coverage and accessibility of ART services. With technological advancements, the rates of preterm birth and low birth weight remain relatively stable, and even decrease in twin and multiple newborns.

Objective To investigate the effect of loganin(Log)on glutamine metabolism in cervical cancer through the regula-tion of nuclear factor red blood cell 2 related factor 2(NFE2L2)-ferritin heavy chain 1(FTH1)-glutathione peroxidase 4(GPX4).Methods Bioinformatics analysis was conducted to identify common targets of Log,glutamine metabolism,and cervical cancer.Hela cells were divided into Blank,control(Ctrl),Log,cisplatin(DDP),NFE2L2 activator(TBHQ),NFE2L2 inhibitor(ML385),and TBHQ+Log groups to detect cell proliferation,invasion,apoptosis,glutamine metabolism,and the protein expression of NFE2L2,FTH1,and GPX4.A cervical cancer xenograft mouse model was established to investigate the in vivo effects of Log on the progression of cervical cancer.Results Bioinformatics analysis confirmed that NFE2L2 might be a target of Log in the treatment of cervical cancer.Both Log and DDP reduced the proliferation and invasion abilities of Hela cells,increased apoptosis,and decreased the levels of glutamine and glutamic acid,as well as the protein expression of glutaminase(GLS1)and glutamic dehydrogenase(GLUD1,P<0.05).The NFE2L2 activator TBHQ had opposite effects,whereas ML385 had a similar impact on the Log.Additionally,Log treatment inhibited the protein expression of NFE2L2,FTH1,and GPX4(P<0.05).Animal experiments showed that Log significantly inhibited cervical cancer progression(P<0.05).Conclusion Log affects cervical cancer progression via glutamine metabolism by inhibiting the NFE2L2-FTH1-GPX4 signaling pathway.