Objective To investigate the distribution of plantar pressures and bone stresses of the foot with high,normal and low arch morphologies,and reveal the influence of arch morphology on foot biomechanical properties.Methods A total of 127 young females were recruited.The foot type was classified by collecting the morphological data of the foot with the three-dimensional(3D)foot scanner,and three types of the foot arch morphology were selected for analysis.The geometric model of foot bone was obtained by CT scanning,so as to establish the biomechanical finite element model of the foot.A load of 50％human body weight was applied to the model to simulate the state of bipedal standing.Results The calculated plantar contact area was compared with the measured results,and the relative error values were smaller than 10％,which proved the validity of the finite element model.The peak plantar pressure under three types of arch morphologies was located in the hind foot region,and the heel pressure of high-and low-arched foot was higher than that of normal-arched foot.Compared with normal-arched foot,high-arched foot showed a significant increase in stress in the hind foot area,the peak stress of soft tissues was 299.45％higher,and the peak bone stress was 93.19％higher.For low-arched foot,the plantar contact area increased by 13.28％and calcaneal stress increased by 98.09％.The peak bone stresses of high-,normal-and low-arched foot were located at the talus,which were 9.903,19.921 and 36.308 MPa,respectively.Conclusions This study supports the association between abnormal arch morphology,foot pain and foot diseases,and provides a basis and direction for the design of orthopedic insoles and arch support structures for abnormal feet.

To address the problem of data silos in dental specialties caused by equipment heterogeneity, this study developed an Intelligent Internet of Things (IoT)-enabled dental chair platform (hereinafter referred to as the intelligent platform) based on the concept of medical-engineering integration. The platform adopts a three-tier chair-domain interconnection architecture: the bottom tier integrates multi-source sensors and standardized interfaces for automated data acquisition and linkage with hospital information systems; the middle tier provides clinic-level management and remote teaching collaboration; and the top tier employs a blockchain-based secure cloud database for resource allocation and data management. Clinical validation at The Affiliated Stomatological Hospital of Nanjing Medical University demonstrated that, compared with a control group from the same period in 2023, the trial group achieved a 38.0% increase in average daily patient visits (80.6±6.8 vs. 58.4±5.2, t=15.16, P<0.001), a 24.6% reduction in average treatment time [(36.1±6.3) min vs. (47.9±8.5) min, t=7.72, P<0.001], a 39.2% reduction in waiting time [23.3 (16.5, 30.1) min vs. 38.3 (28.3, 48.3) min, U=32.00, P<0.001], a 30.4% reduction in equipment idle rate [8.7% (5.1%, 12.3%) vs. 12.5% (7.4%, 17.6%), U=251.00, P=0.003], and an increase in patient satisfaction from 88.2% (1 519/1 723) to 94.3% (2 186/2 318) ( t=7.26, P<0.001). User research confirmed that the functions most favored by clinicians and patients were "dental chair parameter updating and clinical data integration" [74.7% (80/107)] and "chairside display of diagnostic images" [76.8% (119/155)], respectively. Looking forward, the intelligent platform has the potential to integrate artificial intelligence-assisted diagnosis and 5G-enabled multicenter collaboration to further expand its clinical applications and accelerate the digital transformation of dental healthcare.

In order to fully consider the physiological characteristics and movement mechanism of the human body under the premise of ensuring the function and practicality of the product,the human-fabric contact finite element model based on biomechanical feedback plays an important role in the design of'people-oriented'health protection products.This review focuses on the design of protective products made of flexible materials,and discusses the application status and development trend of human finite element model in the design of protective products.The construction process of finite element models of different parts of the human body in recent years is summarized from the perspective of human biomechanics.Secondly,from the contact models established between the human head,torso,upper limbs and lower limbs and protective devices,the application status and challenges of finite element method in the design of health protective products are sorted out.Finally,the problems existing in the use of finite element method in such researches are discussed.It is pointed out that in the context of pursuing accuracy,real-time and realism,finite element contact models with the advantages of high efficiency,precision and reusability still have a broad application prospect.

To address the problem of data silos in dental specialties caused by equipment heterogeneity, this study developed an Intelligent Internet of Things (IoT)-enabled dental chair platform (hereinafter referred to as the intelligent platform) based on the concept of medical-engineering integration. The platform adopts a three-tier chair-domain interconnection architecture: the bottom tier integrates multi-source sensors and standardized interfaces for automated data acquisition and linkage with hospital information systems; the middle tier provides clinic-level management and remote teaching collaboration; and the top tier employs a blockchain-based secure cloud database for resource allocation and data management. Clinical validation at The Affiliated Stomatological Hospital of Nanjing Medical University demonstrated that, compared with a control group from the same period in 2023, the trial group achieved a 38.0% increase in average daily patient visits (80.6±6.8 vs. 58.4±5.2, t=15.16, P<0.001), a 24.6% reduction in average treatment time [(36.1±6.3) min vs. (47.9±8.5) min, t=7.72, P<0.001], a 39.2% reduction in waiting time [23.3 (16.5, 30.1) min vs. 38.3 (28.3, 48.3) min, U=32.00, P<0.001], a 30.4% reduction in equipment idle rate [8.7% (5.1%, 12.3%) vs. 12.5% (7.4%, 17.6%), U=251.00, P=0.003], and an increase in patient satisfaction from 88.2% (1 519/1 723) to 94.3% (2 186/2 318) ( t=7.26, P<0.001). User research confirmed that the functions most favored by clinicians and patients were "dental chair parameter updating and clinical data integration" [74.7% (80/107)] and "chairside display of diagnostic images" [76.8% (119/155)], respectively. Looking forward, the intelligent platform has the potential to integrate artificial intelligence-assisted diagnosis and 5G-enabled multicenter collaboration to further expand its clinical applications and accelerate the digital transformation of dental healthcare.

Objective:To investigate the effectiveness and safety of secondary cytoreductive surgery (SCS) in patients with platinum-sensitive recurrent epithelial ovarian cancer who progressed after first-line maintenance therapy with poly adenosine diphosphate ribose polymerase inhibitor (PARPi).Methods:Clinical pathological data and prognostic information were retrospectively collected from 30 ovarian cancer patients who underwent SCS between January 2018 and June 2024. The Kaplan-Meier method was used to analyze the second progression-free survival (PFS2) time and 3-year overall survival (OS) rate.Results:(1) Primary treatment: the median age at diagnosis was 51.3 years. A total of 40% (12/30) patients underwent primary debulking surgery with an expectation of achieving no gross residual disease (R0), while 60% (18/30) received neoadjuvant chemotherapy and interval debulking surgery. Optimal cytoreduction was achieved in 93% (28/30) of patients. BRCA1/2 gene testing was performed in 29 patients (testing rate 97%, 29/30), identifying 11 BRCA-mutated (37%, 11/30) and 18 BRCA wild-type (60%, 18/30) patients. The median duration of PARPi maintenance therapy among the 30 patients was 11.9 months; patients with BRCA gene mutations had a median duration of 19.2 months, while those with BRCA wild-type had a median duration of 10.1 months. (2) Secondary surgery: pathologically confirmed recurrence patterns, single lesion in 9 patients (30%, 9/30), oligo-lesion (2 lesions) in 3 patients (10%, 3/30), and multi-lesion (≥3 lesions) in 18 patients (60%, 18/30). Among the 30 patients, optimal cytoreduction was achieved in 97% (29/30) of SCS patients, with suboptimal cytoreduction in 1 patient (3%, 1/30). Adjuvant chemotherapy included platinum+paclitaxel in 24 (80%, 24/30) patients and platinum+liposomal doxorubicin in 6 (20%, 6/30) patients. PARPi re-treatment was administered to 17 patients (57%, 17/30) after chemotherapy. (3) Efficacy and safety: as of the follow-up cutoff in June 2024, the median follow-up time was 28.0 months. A total of 19 (63%, 19/30) patients experienced the next recurrence. The median PFS2 time after SCS was 18.5 months. Recurrence occurred in 7 BRCA-mutated and 12 BRCA gene wild-type patients. Median PFS2 time was significantly longer in BRCA-mutated patients compared to BRCA wild-type patients (25.7 vs 14.1 months; P=0.028). Three deaths occurred during follow-up, resulting in a 3-year OS rate of 90%. Among the 30 patients, postoperative complications occurred in 4 patients (13%, 4/30). One patient developed a ureteral fistula on 7 days post-SCS requiring ureteral stenting, and one patient was transferred to the intensive care unit on 1 day post-SCS due to hypovolemic shock. No deaths occurred within 30 days after SCS. Conclusion:For platinum-sensitive recurrent ovarian cancer patients progressed after first-line PARPi maintenance therapy who are anticipated to achieve R0 resection, SCS represents a safe and effective second-line treatment option.

Objective:To apply quality function deployment(QFD)method to formulate management strategy for usage quality of medical equipment,so as to provide a reference for ensuring the safety of using medical equipment.Methods:A questionnaire about the guarantee for the requirement of usage quality of medical equipment was designed,so as to obtain the information of the users of clinical department of The Affiliated Xinghua Hospital to Kangda College of Nanjing Medical University for the requirement of usage quality of medical equipment in using medical equipment from February to April 2024,and confirm the important degree of the requirement.Then,the QFD method was adopted to convert the requirements of users for medical equipment to the required technical indicators of guaranteeing usage quality of medical equipment,and the priority technical guarantee measures of the important degree were quantitatively obtained.Results:A total of 478 questionnaires were issued,and 442 valid questionnaires were retrieved,and the valid recovery rate of questionnaire was 92.47%.The questionnaire identified and analyzed 12 requirements of three dimensions of users in using medical equipment,and they were converted to the top six technical guarantee measures of the strategy of quality management of using medical equipment,which included equipment function,criticality of equipment mission,type of service provider,compliance of rules and regulations,requirements of maintenance,and service life.Conclusion:QFD method can help medical engineering department to establish a management system of usage quality with quantitative analysis for medical equipment,and enhance the management level for the quality of medical equipment in medical institutions,and realize maximize benefit of medical equipment.

Objective:To explore the correlative factors for insomnia severity in chronic insomnia patients using MemTrax memory test.Methods:Two hundred and twenty-two chronic insomnia patients (insomnia≥3 days per week with a duration≥3 months) recruited from Center for Preventive Treatment of Diseases, Guangdong Provincial Hospital of Chinese Medicine or through in-hospital advertisements from April 2024 to September 2024 were chosen. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality over the last month; according to PSQI score, these patients were divided into mild insomnia group (scores of 7-10), moderate insomnia group (scores of 11-15) and severe insomnia group (scores of 16-21). MemTrax memory test was used to record the picture recognition accuracy and picture recognition reaction time, and MemTrax comprehensive index (MTx-Cp) was calculated; Patients' Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder-7 scale(GAD-7) were used to evaluate the depression and anxiety status of these patients in recent 2 weeks. The clinical data, MemTrax test results, PHQ-9 and GAD-7 scores of patients with different degrees of chronic insomnia were compared. Spearman rank correlation analysis was used to investigate the correlation between insomnia severity and clinical data such as cognitive memory function in chronic insomnia patients.Results:Among the 220 chronic insomnia patients, 54 had mild insomnia, 111 had moderate insomnia, and 55 had severe insomnia. Severe insomnia patients had significantly higher percentages of those>50 years old and those using hypnotics compared with mild insomnia patients and moderate insomnia patients ( P<0.05). Compared with the mild insomnia patients and moderate insomnia patients, the severe insomnia patients exhibited significantly lower picture recognition accuracy (90%[86%, 94%], 88%[82%, 94%], 84%[78%, 92%]), significantly lower MTx-Cp (88.55±18.67, 84.41±20.93, 76.69±17.43), and significantly higher PHQ-9 score (9[6, 11], 9[6, 15], 12[8, 16], P<0.05). Moreover, severe insomnia patients had significantly longer picture recognition reaction time and higher GAD-7 score than mild insomnia patients (1.11[1.03, 1.24] s vs. 1.04[0.90, 1.15] s; 7[5, 13] vs. 6[3, 9], P<0.05). Spearman rank correlation analysis showed that insomnia severity in chronic insomnia patients was positively correlated with age, PHQ-9 score, GAD-7 score, and picture recognition reaction time, and negatively correlated with picture recognition accuracy and MTx-Cp ( P<0.05). Conclusion:Insomnia severity in patients with chronic insomnia is correlated with age, cognitive memory function, depression and anxiety.

Objective:To investigate the effectiveness and safety of secondary cytoreductive surgery (SCS) in patients with platinum-sensitive recurrent epithelial ovarian cancer who progressed after first-line maintenance therapy with poly adenosine diphosphate ribose polymerase inhibitor (PARPi).Methods:Clinical pathological data and prognostic information were retrospectively collected from 30 ovarian cancer patients who underwent SCS between January 2018 and June 2024. The Kaplan-Meier method was used to analyze the second progression-free survival (PFS2) time and 3-year overall survival (OS) rate.Results:(1) Primary treatment: the median age at diagnosis was 51.3 years. A total of 40% (12/30) patients underwent primary debulking surgery with an expectation of achieving no gross residual disease (R0), while 60% (18/30) received neoadjuvant chemotherapy and interval debulking surgery. Optimal cytoreduction was achieved in 93% (28/30) of patients. BRCA1/2 gene testing was performed in 29 patients (testing rate 97%, 29/30), identifying 11 BRCA-mutated (37%, 11/30) and 18 BRCA wild-type (60%, 18/30) patients. The median duration of PARPi maintenance therapy among the 30 patients was 11.9 months; patients with BRCA gene mutations had a median duration of 19.2 months, while those with BRCA wild-type had a median duration of 10.1 months. (2) Secondary surgery: pathologically confirmed recurrence patterns, single lesion in 9 patients (30%, 9/30), oligo-lesion (2 lesions) in 3 patients (10%, 3/30), and multi-lesion (≥3 lesions) in 18 patients (60%, 18/30). Among the 30 patients, optimal cytoreduction was achieved in 97% (29/30) of SCS patients, with suboptimal cytoreduction in 1 patient (3%, 1/30). Adjuvant chemotherapy included platinum+paclitaxel in 24 (80%, 24/30) patients and platinum+liposomal doxorubicin in 6 (20%, 6/30) patients. PARPi re-treatment was administered to 17 patients (57%, 17/30) after chemotherapy. (3) Efficacy and safety: as of the follow-up cutoff in June 2024, the median follow-up time was 28.0 months. A total of 19 (63%, 19/30) patients experienced the next recurrence. The median PFS2 time after SCS was 18.5 months. Recurrence occurred in 7 BRCA-mutated and 12 BRCA gene wild-type patients. Median PFS2 time was significantly longer in BRCA-mutated patients compared to BRCA wild-type patients (25.7 vs 14.1 months; P=0.028). Three deaths occurred during follow-up, resulting in a 3-year OS rate of 90%. Among the 30 patients, postoperative complications occurred in 4 patients (13%, 4/30). One patient developed a ureteral fistula on 7 days post-SCS requiring ureteral stenting, and one patient was transferred to the intensive care unit on 1 day post-SCS due to hypovolemic shock. No deaths occurred within 30 days after SCS. Conclusion:For platinum-sensitive recurrent ovarian cancer patients progressed after first-line PARPi maintenance therapy who are anticipated to achieve R0 resection, SCS represents a safe and effective second-line treatment option.

Objective:To explore the relapse-related genes and their clinicopathological connections of diffuse large B cell lymphoma (DLBCL).Methods:Targeted panel sequencing was conducted on 32 eligible DLBCL samples; the patients were diagnosed, treated, and went into complete remission at the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2019, including 14 cases with recurrence (relapsed group) and 18 cases with long-term complete remission of over five years (remission group). Clinical and pathological data were further reviewed. Fisher′s exact test was employed to compare the differences in clinicopathological characteristics and mutation patterns between the two groups.Results:Among the 32 patients, there were 18 males and 14 females, with a male to female ratio of 1.3∶1.0 and a median age of 53 (45.5, 67.0) years. In the relapsed group, PIM1 (11/14), KMT2D (7/14), PRDM1 (6/14), MYD88 (6/14), DTX1 (6/14) emerged as the most frequently mutated genes. In the remission group, while recurrent PIM1, KMT2D and MYD88 mutations were also observed, the TP53 gene exhibited the highest mutation frequency (6/18). Compared to the remission group, relapsed group showed elevated mutation frequencies of PIM1 ( P=0.013) and FAT4 ( P=0.010), alongside a reduced incidence of TP53 mutations. In all 32 patients, DLBCL with CD79B, CCND3, DTX1, KMT2D and PRDM1 mutations demonstrated a propensity towards advanced clinicopathologic stage. Conclusions:Relapsed DLBCL has distinctive clinicopathological and genetic features. PIM1 and FAT4 may be served as potential biomarkers for screening relapsed DLBCL-NOS and as targets for novel therapeutic strategies.

Objective:To explore the clinical and pathological features of EBV-positive diffuse large B cell lymphoma (EBV +DLBCL) and to analyze the prognostic significance of CD30 expression in this entity. Methods:A retrospective analysis was conducted from 34 cases of EBV +DLBCL and 198 cases of EBV -DLBCL diagnosed and treated at the First Affiliated Hospital of Nanjing Medical University, from January 2017 to June 2023. Based on CD30 expression, 34 patients with EBV +DLBCL were categorized into CD30-positive and CD30-negative groups. Fisher exact test and Kaplan-Meier survival curves were employed to analyze the relationship between CD30 expression and clinicopathological parameters as well as its prognostic implications. Chi-square tests were used to compare the clinicopathological features between EBV +DLBCL and EBV -DLBCL. Results:There were 19 males and 15 females with a median age of 69.5 (15-83) years in the EBV +DLBCL group. Compared with EBV -DLBCL, EBV +DLBCL was more likely to present with clinical features such as B symptoms ( χ2=23.818, P<0.001), Ann Arbor stage Ⅲ-Ⅳ ( χ2=8.540, P=0.003), ECOG (Eastern Cooperative Oncology Group Performance Status) score 2-4 ( χ2=6.722, P=0.010), IPI score 3-5 ( χ2=9.953, P=0.002), and involvement of more than one extranodal site ( χ2=6.825, P=0.009). Additionally, EBV +DLBCL exhibited higher frequencies of elevated LDH ( χ2=4.307, P=0.038), CRP ( χ2=5.596, P=0.018), and β2-MG ( χ2=7.008, P=0.008) levels. Histopathologically, EBV +DLBCL was more commonly of the non-GCB subtype ( χ2=12.421, P<0.001), with higher frequencies of CD30-positive ( χ2=62.706, P<0.001),CD10-negative ( χ2=8.687, P=0.003),bcl-6-negative ( χ2=11.123, P<0.001), and bcl-2-negative ( χ2=22.779, P=0.003) expression. Using 20% as the positive threshold for CD30, the CD30-positive group had a higher proliferation index ( P=0.045). No significant differences were observed in overall survival between the two groups. Conclusions:EBV +DLBCL is more prevalent in the elderly and often exhibits aggressive clinical features. The expression of CD30 is not associated with the overall prognosis of EBV +DLBCL.