ObjectiveTo investigate the recurrence of ischemic stroke (IS) and to analyze the association between four indices of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) and the risk of IS recurrence by analyzing the follow-up data related to IS in the community-based natural population of Songjiang District, Shanghai, so as to provide a scientific basis for improving the prognosis of stroke patients in the community and controlling IS recurrence. MethodsA prospective follow-up study was conducted among the IS patients in the community-based cohort population, collecting data about patient’s age, gender, disease history, biochemical indicators, and etc. Cox regression model and restricted cubic spline model were used to analyze the relationship between different levels of plasma lipids and the recurrence of IS in these patients. ResultsA total of 1 368 patients with IS were included. The total follow-up duration was 7 171.46 person-years, with a median follow-up time of 6.24 years. There were 420 cases of IS recurrence, resulting in a cumulative recurrence rate of 30.70%. The results of multivariate Cox regression analysis showed that the recurrence risk of IS was reduced when the baseline TC and LDL-C levels of IS patients were in the ranges of 4.65‒5.67 mmol·L^-1 and 2.52‒3.46 mmol·L^-1, respectively. The results of restricted cubic spline analysis showed a U-shaped relationship between baseline TC and LDL-C levels and the recurrence risk in IS patients. ConclusionThe cumulative recurrence rate of patients with IS in the community of Songjiang District in Shanghai is high, and the levels of TC and LDL-C at baseline survey are correlated with the recurrence of IS in these patients. It is suggested to pay more attention to the levels of LDL-C and TC in patients with IS, so as to improve the prognosis.

Hepatocellular carcinoma (HCC) is one of the most common malignancies and is a major cause of cancer-related mortalities worldwide (Forner et al., 2018; He et al., 2023). Sarcopenia is a syndrome characterized by an accelerated loss of skeletal muscle (SM) mass that may be age-related or the result of malnutrition in cancer patients (Cruz-Jentoft and Sayer, 2019). Preoperative sarcopenia in HCC patients treated with hepatectomy or liver transplantation is an independent risk factor for poor survival (Voron et al., 2015; van Vugt et al., 2016). Previous studies have used various criteria to define sarcopenia, including muscle area and density. However, the lack of standardized diagnostic methods for sarcopenia limits their clinical use. In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP) renewed a consensus on the definition of sarcopenia: low muscle strength, loss of muscle quantity, and poor physical performance (Cruz-Jentoft et al., 2019). Radiological imaging-based measurement of muscle quantity or mass is most commonly used to evaluate the degree of sarcopenia. The gold standard is to measure the SM and/or psoas muscle (PM) area using abdominal computed tomography (CT) at the third lumbar vertebra (L3), as it is linearly correlated to whole-body SM mass (van Vugt et al., 2016). According to a "North American Expert Opinion Statement on Sarcopenia," SM index (SMI) is the preferred measure of sarcopenia (Carey et al., 2019). The variability between morphometric muscle indexes revealed that they have different clinical relevance and are generally not applicable to broader populations (Esser et al., 2019).
Humans ; Aged ; Sarcopenia/diagnostic imaging* ; Carcinoma, Hepatocellular/diagnostic imaging* ; Muscle, Skeletal/diagnostic imaging* ; Deep Learning ; Prognosis ; Radiomics ; Liver Neoplasms/diagnostic imaging* ; Retrospective Studies

In order to promote the innovative application of Sanjiao theory and Yingwei theory， this paper tries to apply the ''Sanjiao-Yingwei'' Qi transformation theory to the treatment of tumor diseases， integrating it with T cell exhaustion mechanism to elaborate on its scientific connotation and using network pharmacology and bioinformatics to elucidate the correlation between the anti-tumor mechanism of ''Sanjiao-Yingwei'' Qi transformation and T cell exhaustion. The ''Sanjiao-Yingwei'' Qi transformation function is closely related to the immunometabolic ability of the human body， and the ''Sanjiao-Yingwei'' Qi transformation system constitutes the immunometabolic exchange system within and outside the cellular environment. Cancer toxicity is generated by the fuzzy Sanjiao Qi， and the long-term fuzzy Sanjiao Qi is the primary factor leading to T cell exhaustion， which is related to the long-term activation of T cell receptors by the high tumor antigen load in the tumor microenvironment. Qi transformation malfunction of the Sanjiao produces phlegm and collects stasis， which contributes to T cell exhaustion and is correlated with nutrient deprivation， lipid accumulation， and high lactate levels in the immunosuppressed tumor microenvironment， as well as with the release of transforming growth factor-β and upregulated expression of programmed death receptor-1 by tumor-associated fibroblasts and platelets in the tumor microenvironment. Ying and Wei damage due to Sanjiao Qi transformation malfunction is similar to the abnormal manifestations such as progressive loss of exhausted T cell effector function and disturbance of cellular energy metabolism. Guizhi decoction， Shengming decoction， and Wendan decoction can correct T cell exhaustion and exert anti-tumor effects through multi-target and multi-pathways by regulating ''Sanjiao-Yingwei'' Qi transformation， and hypoxia inducible factor-1α （HIF-1α） may be one of the main pathways to correct T cell exhaustion. It was found that HIF-1α may be one of the important prognostic indicators in common tumors by bioinformatics. The use of the ''Sanjiao-Yingwei'' Qi transformation method may play an important part in improving the prognosis of tumor patients in clinical practice.

BACKGROUND:Prosthesis restricted selection,soft tissue release,patellar trajectory recovery,and bone defect reconstruction were need to be optimized in total knee arthroplasty for moderate and severe valgus knee.The medial parapatellar approach has disadvantages in the treatment of valgus knee,such as aggravating the medial soft tissue relaxation.In recent years,it has been found that the lateral parapatellar approach has advantages in the treatment of valgus knee,such as exposure and release. OBJECTIVE:To observe the efficacy of the lateral and medial parapatellar approach in total knee arthroplasty for moderate and severe valgus knee,and to explore a more suitable surgical approach for moderate and severe valgus knee. METHODS:Totally 56 patients with moderate and severe valgus knee underwent total knee arthroplasty and would take turns performing surgery through the medial and lateral parapatellar approach according to the order of admission.The lateral group(n=28)underwent total knee arthroplasty through lateral parapatellar approach,and the medial group(n=28)through medial parapatellar approach.Posterior stablized knee prosthesis was used in all patients.The restricted types of prosthesis,thickness of polyethylene,operation time,amount of blood loss,femoro-tibia angle,patellar tilt angle,range of motion,Hospital for Special Surgery score,Western Ontario and McMaster Universities Arthritis Index(WOMAC)score,and complications were collected as observation indexes for statistical analysis. RESULTS AND CONCLUSION:(1)The utilization rate of condyle-restricted prosthesis in the lateral group was significantly lower than that in the medial group.The average thickness of polyethylene liner was lower,and the operation time was shorter in the lateral group compared with the medial group.There were significant differences between the two groups(P<0.05),and there was no significant difference in the amount of surgical bleeding.(2)56 patients were followed up for an average of 2-5 years.There were no signs of prosthesis loosening or bone resorption in all patients.The average patellar tilt angle and femoral tibial angle of the lateral group were lower than those of the medial group,and the average Hospital for Special Surgery score and WOMAC score of the lateral group were higher than those of the medial group,with significant differences(P<0.05).There was no significant difference in the range of motion of the knees between the two groups.(3)Incision fat liquefaction and calf intermuscular venous thrombosis occurred in one case in each group.No infection,poor incision healing,incisional hematoma,prosthesis dislocation,iatrogenic nerve injury,ectopic ossification,or periprosthesis fracture occurred during follow-up.(4)In conclusion,the treatment of moderate and severe valgus knee by lateral parapatellar approach can better protect the tension of the medial soft tissue of the knee,use less condylar restrictive prostheses,and have a more friendly patellar trajectory and higher postoperative function score.

Ehlers-Danlos syndromes (EDS) are a group of rare hereditary connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Short stature is defined as a height that is two standard deviations or more below the average height for individuals of the same age, sex, and race. The etiopathogenesis of short stature is complicated. Early detection and appropriate intervention are essential in disease treatment. However, short stature is not common among all EDS subtypes. It is frequently observed in patients with rare subtypes, such as spondylodysplastic EDS, dermatosparaxis EDS, and musculo-contractural EDS. Besides, height may be affected by other factors including spinal curvature and malnutrition. Deep phenotyping and multidisciplinary team approaches are recommended for the diagnosis and management. Short stature in patients with EDS has not been sufficiently acknowledged in China. There is currently a lack of high-level evidence for the treatment of EDS-related short stature. Therefore, this review aims to present recent progress of diagnosis and management of short stature in patients with EDS. Further studies focusing on short stature in rare subtypes are necessary to advance precision medicine and enhance patient care.

The Ehlers-Danlos syndromes(EDS)are a group of rare hereditary connective tissue disorders characterized by joint hypermobility,skin hyperextensibility,and tissue fragility.The clinical and genetic hetero-geneity of EDS frequently leads to underdiagnosis and misdiagnosis.Genetic testing is an essential approach to clarify the underlying diagnosis.Recent research has preliminarily established genotype-phenotype correlations and introduced the novel concept of"disease spectrum"in some subtypes.These studies deepen our under-standing of EDS etiology and provide important insights into clinical management.Published in 2023,the Chinese Guidelines for Diagnosis and Treatment of the Ehlers-Danlos Syndromes(the Guidelines)recommend performing genetic testing with deep phenotyping for patients who meet the clinical diagnostic criteria or are sus-pected of having EDS.However,it should be noted that the clinical diagnosis might differ from the molecular diagnosis.Furthermore,cutting-edge approaches such as periodic data reanalysis,integration of RNA sequen-cing into family-based whole-genome sequencing,and third-generation sequencing may facilitate the reclassifi-cation of variants of uncertain significance or resolve undiagnosed cases.This article summarizes recent progress in the genetics research of EDS,with the hope of offering a valuable resource for clinical diagnosis,treatment and scientific research to optimize the quality of life of patients with EDS.

Objective To investigate the anti-fatigue effect of PTR-SeNPs in vivo by measuring the muscle relative length of hindlimb,load-bearing swimming time as well as serum and liver indexes of mice.Methods 48 male C57/BL6 mice were randomly assigned into 4 groups with 12 mice in each group,including vehicle control group(control group),swimming training exercise group(EC group)with vehicle treatment,swimming training exercise with low dose of PTR-SeNPs group(LPTR-SeNPs)and high dose of PTR-SeNPs group(HPTR-SeNPs).The mice were intragastrically administrated with normal saline in both control group and EC group,as well as 2.5 and 10 μmol/(kg·bw)PTR-SeNPs in LHPTR-SeNPs group,respectively,once per day for consecutively 21 days.After swimming training exercise,the muscle structures in the hind limb of mice were examined by magnetic resonance imaging.Furthermore,the burdened swimming time was measured,the serum content of blood lactic acid(BLA),urea nitrogen(BUN),alanine aminotransferase(ALT),glutamic oxalate aminotransferase(AST)and lactate dehydrogenase(LDH),as well as the hepatic level of glycogen(HG),malondialdehyde(MDA)and activity of catalase(CAT)and superoxide dismutase(SOD)were determined.Results Compared with the control group,the serum contents of BLA,BUN,ALT,AST and LDH in EC group(P<0.05 or P<0.01)and hepatic CAT in HPTR-SeNPs group(P<0.01)were significantly increased.The muscle relative length of hind limbs and the burdened swimming time were extended by HPTR-SeNPs markedly(P<0.05).There was no significant difference in MDA level in LHPTR-SeNPs group.Compared with EC group,the burdened swimming time of mice was significantly prolonged(P<0.01),the contents of BLA and BUN were obviously decreased in the HPTR-SeNPs group(P<0.05 or P<0.01),the level of HG was significantly increased in the LHPTR-SeNPs groups(P<0.05 or P<0.01),the serum content of ALT,AST and LDH were markedly decreased in the HPTR-SeNPs group(P<0.05 or P<0.01).Hepatic SOD activity was remarkably increased in LPTR-SeNPs group(P<0.05),the level of CAT was evidently increased(P<0.01)and AST was decreased(P<0.05)in the HPTR-SeNPs group.Conclusion PTR-SeNPs could improve the liver physiological function,increase glycogen storage,reduce the accumulation of metabolites and enhance the body's antioxidant capacity to ameliorate fatigue significantly,which could present the potential to be developed into health care products or drugs.

Ardisia Crenata Radix is a traditional Chinese medicinal plant that belongs to the Myrsinaceae family,and its main active components are coumarins,saponins,flavonoids,and volatile oil.Bergenin,ardisicrenoside A,ardisicrenoside B,ardisiacripin A,ardisiacripin B,and embelin were identified as active anticancer compounds in in-depth studies into the anti-tumor effects of Ardisia Crenata Radix.They show high therapeutic potential in oral cancer,nasopharyngeal carcinoma,liver cancer,colon cancer,bladder cancer,cervical cancer,and leukemia,mainly by inducing tumor cell apoptosis,increasing tumor cytotoxicity,inhibiting cell proliferation,inhibiting tumor cell metastasis and migration,and inducing cell regulatory enzyme cascade reactions.However,most preclinical experimental data on cinnabar root's anti-tumor mechanism have not been verified in high-quality,multi-sample,and repeated randomized controlled trials,and there are a lack of clinical research data on tumor prognosis,pharmacodynamics,and pharmacokinetics.Accurate research experiments and clinical trials should be designed to further explore the pharmacological effects of Ardisia Crenata Radix.

Objective:To evaluate the reliability and validity of the Chinese version of HEMO-FISS-QoL(HF-QoL) questionnaire (HF-QoL-C) in the Chinese population with hemorrhoids.Methods:From November 2021 to November 2022, a self-constructed general information questionnaire, HF-QoL-C, and the 36-item short form health survey (SF-36), Goligher classification, and Giordano severity of hemorrhoid symptom questionnaire (GSQ) were used to conduct a questionnaire survey on 760 hemorrhoid patients in the anorectal department of six hospitals. The data was analyzed for reliability and validity using SPSS 21.0 and AMOS 26.0 software.Results:The Cronbach's α coefficient of HF-QoL-C and its dimension ranged from 0.831 to 0.960, and the split coefficient was 0.832-0.915. Four common factors were extracted through principal component exploratory factor analysis. Confirmatory factor analysis indicated acceptable structural validity( χ2/ df=8.152, RSMEA=0.097, CFI=0.881, IFI=0.881, NFI=0.867). HF-QoL-C was correlated with SF36 and GSQ( r=-0.694, 0.501, both P<0.01). There were differences in the total score and dimensional scores of HF-QoL-C between surgical and drug treated patients, different grades of Goligher classification for hemorrhoidal disease, and different ranges of hemorrhoid prolapse (all P<0.001). No ceiling effect was found in the total score and the scores of each dimension(0.3%-2.0%). There was a floor effect in both psychological function and sexual activity dimensions (16.7%, 35.1%). Conclusion:HF-QoL-C has good reliability and validity, which can be used to measure the quality of life of Chinese hemorrhoid patients.