Objective:To analyze the X-ray imaging characteristics of calcaneus in adult patients with osteoarticular diseases and its impact on disease diagnosis.Methods:Totally 78 patients (156 ankle joints) with osteoarticular diseases admitted to the Affiliated Hospital of Jining Medical University from June 2019 to June 2022 were selected as research subjects, including 72 cases of osteoarthritis and 6 cases of Kashin-Beck disease. Another 50 volunteers who underwent health examination in this hospital during the same period were selected as control group, all of them underwent calcaneal X-ray examination. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of calcaneal X-ray parameters in predicting adult osteoarticular diseases.Results:Among 72 patients with osteoarthritis, 63 cases (87.50%) showed joint surface sclerosis in the calcaneal X-ray changes. Forty-seven cases (65.28%) had narrowing of the subtalar joint space; 14 cases showed disappearance of the subtalar joint space, accounting for 19.44%. Among the 6 patients with Kashin-Beck disease, the X-ray changes of the calcaneus showed joint surface sclerosis in 6 cases, narrowing of the subtalar joint space in 4 cases, and disappearance of the subtalar joint space in 2 cases. The length, height, Bohler angle, Gissane angle, and inclination angle of the calcaneus in patients with Kashin-Beck disease were all smaller than those in the osteoarthritis group and the control group, the height to length ratio of the calcaneus was higher than that in the osteoarthritis group and the control group, and the difference was statistically significant ( P < 0.05). The length, height, Bohler angle, Gissane angle, and inclination angle of the calcaneus in patients of the osteoarthritis group were all smaller than those in the control group, and the height to length ratio of the calcaneus was higher than that in control group, and the difference was statistically significant ( P < 0.05). ROC curve analysis showed that the sensitivity of Bohler angle, Gissane angle, and the height to length ratio of the calcaneus in predicting osteoarticular diseases (72 patients with osteoarthritis) were 92.5%, 87.6% and 80.4%, respectively, with specificity of 73.0%, 68.8% and 63.1%, respectively. Conclusion:The calcaneal X-ray manifestations of adult patients with osteoarticular diseases vary greatly, among which Bohler angle, Gissane angle, and height to length ratio of the calcaneus have certain accuracy in diagnosis of osteoarthritis.

Cognitive dysfunction refers to dysfunction of individual perception,memory,understanding,learning,creation and other dysfunctions caused by abnormal brain function and structure.Based on the fact that the spleen can't regulate transportation and transformation,govern blood and send up essential substance,combined with the microbiota-gut-brain axis,this article discussed the etiology and pathogenesis of intestinal flora imbalance affecting cognitive dysfunction in TCM.It was proposed that the spleen in TCM and intestinal flora are connected in physiology and pathology:the spleen regulates spirit and governs cognition,when the spleen fails to function normally that it can't dominate transportation and transformation,govern blood and send up essential substance will cause that the brain spirit can not be nourished;intestinal flora is closely related to the spleen in TCM,and affects brain function through the nervous system,endocrine,immune and metabolic mechanisms.This article can provide explore new ideas for the clinical research and treatment of cognitive dysfunction of traditional Chinese and Western medicine.

Objective To explore the effect mechanism of lipophagy in diabetic nephropathy model rats based on intervention of Dangui Hongqi ultrafiltration in diabetic nephropathy model rats.Methods Fifty male Wistar rats of SPF grade were randomly selected 7 rats as the blank group,and the other 43 rats were given a one-time high-dose intraperitoneal injection of streptozotocin combined with high-fat and high-sugar diet to prepare diabetes nephropathy model.The modeling rats were randomly divided into model group,irbesartan group(17.9 mg/kg),and TCM low-,medium-,and high-dosage groups(1.5,3,6 g/kg).The rats were continuously gavaged by corresponding drugs for 12 weeks.Randomized blood glucose,body mass,and 24 h urine protein content were detected;biochemical tests were used for GSP,SCr,BUN,TG,TC,HDL-C,LDL-C,FFA content;HE staining was used to observe morphology changes in renal tissue,Masson staining was used to observe fibrosis changes in renal tissue,renal tissue microstructure changes were observed under transmisson electron microscopy,RT-qPCR was used to detect the mRNA expressions of mTOR and LC3B in renal tissue,and Western blot was used to detect the protein expressions of mTOR,TFEB,p-TFEB,and LC3B in renal tissue.Results Compared with the blank group,the model group rats showed a significant increase in randomized blood glucose(P<0.01),a significant decrease in body mass(P<0.01),a significant increase in 24 h urine protein content(P<0.01),a significant increase in GSP,SCr,BUN,TG,TC,LDL-C,FFA content(P<0.01),and a significant decrease in HDL-C content(P<0.01);renal tubular epithelial cells underwent vacuolar degeneration,cytoplasmic vacuolization,and extensive infiltration of inflammatory cells,collagen fibers increased and were distributed randomly,the number of lipid droplets increased,and autophagosomes decreased;the mTOR mRNA expressions in renal tissue significantly increased(P<0.01),the LC3B mRNA expressions significantly decreased(P<0.01),the mTOR and p-TFEB protein expressions significantly increased(P<0.01),the expression of TFEB,LC3BⅡ protein significantly decreased(P<0.01).Compared with the model group,the randomized blood glucose and 24 h urine protein content of rats in each treatment group were significantly reduced,the body mass significantly increased,and the contents of GSP,SCr,BUN,TG,TC,LDL-C,FFA decreased at 12 week of treatment,while the content of HDL-C increased;the inflammatory cell infiltration,fibrosis,and lipid droplet deposition in renal tissue alleviated to varying degrees;the expressions of mTOR mRNA decreased,the expressions of LC3B mRNA increased,the expressions of mTOR and p-TFEB protein decreased,while the expression of TFEB and LC3BⅡ protein increased.There was a statistically significant difference in the irbesartan group and TCM high-dosage group(P<0.01,P<0.05).Conclusion Dangui Hongqi ultrafiltration can improve the disorder of glucose and lipid metabolism,antagonize heterotopic lipid deposition in the kidney,promote lipid phagocytosis,and delay the process of diabetic nephropathy in model rats.The mechanism may be related to mTOR/TFEB signaling pathway.

Objective To evaluate the dosimetric effect of three-dimensional(3D)printed headrests made of different materials in radiotherapy for head and neck tumor,and to evaluate whether the existence of customized 3D-printed headrest can be neglected during planning phase by comparing differences in target area doses,homogeneity index(HI),conformity index(CI),monitor units(MU),and organ-at-risk(OAR)dose.Methods Ten patients with head and neck tumors,including 5 cases with nasopharyngeal carcinoma and 5 with other head and neck tumors,were enrolled.The headrest contours were outlined using Monaco treatment planning system,and with the same calculation parameters,treatment plans were generated for scenarios without a headrest,with a standard headrest,and with 3D-printed headrests made of 10%filled polylactic acid and thermoplastic polyurethane.The target area doses,OAR dose,MU,and other results were recorded and subjected to statistical analysis.Results No significant differences were observed among the 4 groups(ignoring headrest,standard headrest,3D-printed headrests with 10%filled polylactic acid and thermoplastic polyurethane)in parameters such as D95,D5,Dmean,HI,CI,MU,and OAR dose(the maximum dose to the spinal cord)(P>0.05).Considering the presence of the headrest,significant differences were found in CI for nasopharyngeal carcinoma and other head and neck tumors(P<0.05).Conclusion During the planning phase,the existence of customized 3D-printed headrest can be ignored,but it should be noted that the presence of a headrest may reduce the MU in radiotherapy plans.When considering the headrest,the average CI of patients with other head and neck tumors is significantly higher than that with nasopharyngeal carcinoma.

Objective:To understand the barriers to active aging among elderly people in western China and provide reference for formulating targeted interventions.Methods:This study was a qualitative study. From September to December 2022, purposive sampling was used to select 15 elderly people from Chengdu as the research subject for semi-structured interviews. Data analysis was conducted using the Colizzi 7-step analysis method.Results:The barriers to the active aging of elderly people in western China included three themes and six sub-themes, namely low levels of health self-management (low level of health awareness, lack of healthy lifestyle), hindered social participation (low personal willingness to participate in society, weak social participation support system), and weak social security system (heavy burden of medical care, poor accessibility of multi-channel elderly care services) .Conclusions:There are many barriers in the active aging process of elderly people in the western region of China. While improving the elderly care system and expanding service supply, society should fully consider the needs of the elderly, exert their subjective initiative, create an active aging atmosphere, and promote the smooth realization of active aging for the elderly in western China.

Objective     To explore the feasibility of 5G remote robot-assisted pulmonary lobectomy through animal experiments. Methods     In this research, the Toumai® surgical robot was manipulated remotely by the surgeon in the Control Center of the MedBot Company through the 5G network established by China Telecom, and the experimental pig underwent lobectomy in simulated operating room. Results     The animal experiment surgery was successfully completed. The surgeon remotely manipulated the surgical robot to complete the lobectomy of right apical lobe and mediastinal lymph node dissection. The entire animal experiment took about 60 minutes, with an average round-trip network delay of 125 (110-155) ms, and no network interruption or robot malfunction occurred. Conclusion     This animal experiment is the first attempt of 5G remote thoracic surgery, which preliminarily proves the feasibility of completing remote lobectomy through the Toumai® surgical robot 5G wireless network connection. The systematic surgical procedure is summarized, which lays a foundation for the subsequent experiments and clinical applications of 5G remote robot-assisted thoracic surgery.

With the continuous progress of research methodology in the real world and the growing maturity of artificial intelligence technology， a method for conducting “quantitative” research to guide clinical practice based on traditional Chinese medicine （TCM） diagnosis and treatment data was gradually developed. However， there is still a need for further improvements in the overall design of studies and the transformation of findings into clinical practice. Based on this， we put forward a comprehensive overall design concept and application approach for real-world study and artificial intelligence research based on clinical diagnosis and treatment data of TCM. This approach consists of five steps： Constructing a research-based database with a large sample size and high data quality； Mining and classification of core prescriptions； Conducting cohort studies to evaluate the effectiveness of core prescriptions； Utilizing case-control studies to clarify the dominant population； Establishing predictive models to achieve precision medicine. Additionally， it is imperative for researchers to establish a standardized system for collecting TCM variables and processing data， optimize the determination and measurement methods of confounding factors， further improve and promote methodologies， and strengthen the training of interdisciplinary talents. By following this research method， we anticipate that the clinical translation of research findings will be facilitated， leading to advancements in TCM precision medicine. Real-world study and artificial intelligence research share similar research foundations， and clinical applications complement each other. In the future， the two will merge together.

Objective : To investigate the effects of miR⁃26a⁃3p on rat myocardial cell ( H9c2) injury induced by hypoxia/reoxygenation (H/R) and its mechanism . Methods : H9c2 cardiomyocytes in logarithmic growth phase were subjected to hypoxia (1% O2 ) for 6 h , and reoxygenated at different times (2 , 4 , 8 , 12 h) to establish H/R model cell . Normoxia group was also set up , and cell proliferation activity was detected by cell counting kit⁃8 (CCK⁃8) . The level of lactic dehydrogenase (LDH) in cell supernatant was determined by colorimetry . The expression levels of miR⁃26a⁃3p and Survivin mRNA were detected by real⁃time fluorescence quantitative PCR (qRT⁃PCR) . The expression level of Survivin protein in the cells was detected by Western blot . H9c2 cells were transfected with miR⁃26a⁃3p inhibitor and negative control inhibitor NC , Survivin gene siRNA interference plasmid ( si⁃Survivin) and negative control si⁃NC , followed by H/R intervention . CCK⁃8 was used to detect cell proliferation in each group . The activity of superoxide dismutase (SOD) and the content of malonaldehyde (MDA) in cell and the level of LDH in supernatant were determined by colorimetry . The apoptosis level of each group was detected by flow cytometry . The protein expression levels of Bcl⁃2 associated X protein ( Bax) , B ⁃cell lymphoma⁃2 ( Bcl⁃2 ) , cleaved caspase⁃3 and Survivin were detected by Western blot . Targeting relationship between miR⁃26a⁃3p and Survivin gene was determined by dual luciferase . Results : Compared with the normoxia group , proliferative activity , mRNA and protein expression levels of Survivin in H9c2 cells gradually decreased with the extension of reoxygen ation time (P < 0. 05) , while LDH and expression level of miR⁃26a⁃3p gradually increased ( P < 0. 05) . Downregulating the expression of miR⁃26a⁃3p increased proliferative activity , SOD activity , and expression level of Bcl⁃2 protein in H9c2 cells exposed to H/R ( P < 0. 05) , while MDA content , LDH release amount , apoptosis rate , expression levels of Bax and cleaved caspase⁃3 protein decreased (P < 0. 05) . Survivin deficiency reversed the protective effect of miR⁃26a⁃3p inhibitor on H9c2 cells induced by H/R . Dual luciferase reporter gene assay confirmed that Survivin was the target gene of miR⁃93 ⁃5p . Conclusion miR⁃26a⁃3p is highly expressed in cardiomyocyte injury induced by H/R . Inhibition of miR⁃26a⁃3p expression can inhibit H/R⁃induced cardiomyocyte apoptosis and oxidative stress by targeted up⁃regulation of Survivin expression .

Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.

Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.