Objective:To investigate the effects of annulus fibrosus(AF)suture or not on the lumbar biome-chanics following microendoscopic discectomy(MED)through establishing finite element models(FEMs)of unsu-tured AF incision and sutured AF incision.Methods:A 27-year-old healthy young adult male volunteer was recruited and underwent lumbar CT to exclude spinal deformities,tumors,and other osseous pathologies.CT images of the L4/L5 segment were imported into the software Mimics for three-dimensional reconstruction and contour extraction.The resulting model was further processed using Geomagic,SolidWorks,and Workbench for solid modeling.An intact L4/5 segment model,an L4/5 model with an unsutured AF incision following MED(unsutured AF model),and an L4/5 model with a sutured AF incision following MED(sutured AF model)were established.Intervertebral range of motion(ROM),Von-Mises stress on the facet joints,and Von-Mises stress on the AF of the models were measured,and model validity was verified by comparison with previously pub-lished studies.After validation,the inferior end of the L5 vertebral body in all the three models was fixed.An axial load of 500N was applied to the superior end of the L4 vertebral body,and a bending moment of 7.5N·m was separately applied under six physiological loading conditions(flexion,extension,left/right lateral bending,and left/right axial rotation).The biomechanical properties of the three models at the L4/5 level,in-cluding intervertebral ROM and Von-Mises stress in facet joints,and Von-Mises stress on the AF were com-pared under different loading conditions.Results:No significant discrepancies were noted when data obtained under these six motion conditions were compared with the findings from prior literature,thus validating the models.Stress nephogram results revealed that under each motion condition,high-stress areas were located at the unsutured defect of the intervertebral disc AF and the surrounding facet joint processes.Compared with the intact model,the intervertebral ROM of the sutured AF model was 8.6802°,8.596°,4.8514°,5.0249°,2.2474°,and 1.9092°,respectively,under the six motions,while that of the unsutured AF model was 8.7475°,8.9453°,5.6441°,5.2546°,2.5886°,and 1.9487°,respectively.The ROM of the sutured AF model was 9％,19％,44％,38％,50％,and 40％higher than that of the intact model;Compared with the unsutured AF mod-el,it was reduced by 1％,4％,14％,4％,13％,and 2％respectively.For Von Mises stress on the AF under the six motion conditions,the stress of the sutured AF model was 2％,65％,21％,32％,51％,and 38％higher than that of the intact model,but 8％,48％,52％,10％,37％,and 48％lower than that of the unsu-tured AF model respectively.For Von-Mises stress in facet joints,the stress values of the sutured AF model were 12.109MPa,8.3601MPa,13.998MPa,12.969MPa,10.219MPa,and 10.074MPa respectively,while those of the unsutured AF model were 13.399MPa,9.6094MPa,18.175MPa,17.967MPa,12.409MPa,and 11.6384MPa respectively.The stress values of Von-Mises stress in facet joints of the sutured AF model was 5％,10％,32％,17％,31％,and 34％higher than that of the intact model;Compared with the unsutured AF model,it was decreased by 9％,13％,22％,27％,17％,and 13％respectively.Conclusions:Among the three con-structed L4/5 FEMs,the sutured AF model exhibits more favorable intervertebral ROM,and Von-Mises stress of facet joints and AF compared with the unsutured AF model.This indicates that AF suture contributes to enhancing intervertebral stability.

Objective:To investigate the effects of annulus fibrosus(AF)suture or not on the lumbar biome-chanics following microendoscopic discectomy(MED)through establishing finite element models(FEMs)of unsu-tured AF incision and sutured AF incision.Methods:A 27-year-old healthy young adult male volunteer was recruited and underwent lumbar CT to exclude spinal deformities,tumors,and other osseous pathologies.CT images of the L4/L5 segment were imported into the software Mimics for three-dimensional reconstruction and contour extraction.The resulting model was further processed using Geomagic,SolidWorks,and Workbench for solid modeling.An intact L4/5 segment model,an L4/5 model with an unsutured AF incision following MED(unsutured AF model),and an L4/5 model with a sutured AF incision following MED(sutured AF model)were established.Intervertebral range of motion(ROM),Von-Mises stress on the facet joints,and Von-Mises stress on the AF of the models were measured,and model validity was verified by comparison with previously pub-lished studies.After validation,the inferior end of the L5 vertebral body in all the three models was fixed.An axial load of 500N was applied to the superior end of the L4 vertebral body,and a bending moment of 7.5N·m was separately applied under six physiological loading conditions(flexion,extension,left/right lateral bending,and left/right axial rotation).The biomechanical properties of the three models at the L4/5 level,in-cluding intervertebral ROM and Von-Mises stress in facet joints,and Von-Mises stress on the AF were com-pared under different loading conditions.Results:No significant discrepancies were noted when data obtained under these six motion conditions were compared with the findings from prior literature,thus validating the models.Stress nephogram results revealed that under each motion condition,high-stress areas were located at the unsutured defect of the intervertebral disc AF and the surrounding facet joint processes.Compared with the intact model,the intervertebral ROM of the sutured AF model was 8.6802°,8.596°,4.8514°,5.0249°,2.2474°,and 1.9092°,respectively,under the six motions,while that of the unsutured AF model was 8.7475°,8.9453°,5.6441°,5.2546°,2.5886°,and 1.9487°,respectively.The ROM of the sutured AF model was 9％,19％,44％,38％,50％,and 40％higher than that of the intact model;Compared with the unsutured AF mod-el,it was reduced by 1％,4％,14％,4％,13％,and 2％respectively.For Von Mises stress on the AF under the six motion conditions,the stress of the sutured AF model was 2％,65％,21％,32％,51％,and 38％higher than that of the intact model,but 8％,48％,52％,10％,37％,and 48％lower than that of the unsu-tured AF model respectively.For Von-Mises stress in facet joints,the stress values of the sutured AF model were 12.109MPa,8.3601MPa,13.998MPa,12.969MPa,10.219MPa,and 10.074MPa respectively,while those of the unsutured AF model were 13.399MPa,9.6094MPa,18.175MPa,17.967MPa,12.409MPa,and 11.6384MPa respectively.The stress values of Von-Mises stress in facet joints of the sutured AF model was 5％,10％,32％,17％,31％,and 34％higher than that of the intact model;Compared with the unsutured AF model,it was decreased by 9％,13％,22％,27％,17％,and 13％respectively.Conclusions:Among the three con-structed L4/5 FEMs,the sutured AF model exhibits more favorable intervertebral ROM,and Von-Mises stress of facet joints and AF compared with the unsutured AF model.This indicates that AF suture contributes to enhancing intervertebral stability.

Objective:To construct the risk prediction model for early-onset peritoneal dialysis-associated peritonitis (PDAP) in peritoneal dialysis patients based on six machine learning algorithms.Methods:This study was retrospective. Convenience sampling was used to select peritoneal dialysis patients who were regularly followed up in the Department of Nephrology of Guizhou Provincial People's Hospital from December 2009 to August 2023 to collect general information, primary diseases, and laboratory indicators of the study population. It was randomly divided into a modeling set and validation set in the ratio of 7∶3. With the occurrence of early-onset PDAP as the dependent variable, the risk prediction model of early-onset PDAP in peritoneal dialysis patients was constructed based on six machine learning algorithms, namely, Logistic regression, decision tree, support vector machine, random forest, extreme gradient boosting, and artificial neural network, respectively. Model performance was evaluated based on the area under the receiver operating characteristic curve ( AUC) , accuracy, and F1 score to select the optimal model. Results:The final data of 890 peritoneal dialysis patients were analyzed, of which 86 patients developed early-onset PDAP, and the incidence of early-onset PDAP was 9.66%. The four prediction models, Logistic regression, support vector machine, extreme gradient boosting, and random forest, had high accuracy with AUC values of 0.703, 0.729, 0.782, and 0.814, respectively, with the random forest model having higher AUC value, accuracy, and F1 score. Further ranking of the importance of risk factors for early-onset PDAP based on the random forest model showed that the top five characteristic variables were C-reactive protein, triglycerides, platelet, ferritin, and leukocyte, in that order. Conclusions:The risk prediction model for early-onset PDAP in peritoneal dialysis patients constructed based on the random forest model has optimal performance, which can help medical and nursing staff assess and prevent early-onset PDAP at an early stage.

OBJECTIVE To explore the efficacy of platelet-rich plasma （PRP） intrauterine infusion combined with Gushen antai pills in the treatment of recurrent abortion （RSA） and its impacts on endometrial receptivity and hormone levels in patients. METHODS A total of 108 patients with RSA treated in our hospital from January 2021 to January 2024 were selected and evenly divided into control group and study group using the random number table method， with 54 cases in each group. On the basis of conventional treatment， patients in the control group were administered with Gushen antai pills， while patients in the study group received PRP intrauterine infusion combined with Gushen antai pills. The clinical efficacy， TCM syndrome scores before and after treatment， endometrial receptivity [endometrial thickness （EST）， spiral artery resistance index （RI）， and pulsatility index （PI）]， hormone [progesterone （P）， estradiol （E2）， and human chorionic gonadotropin （HCG）] levels， as well as pregnancy outcomes， were compared between the two groups. Additionally， the occurrence of adverse reactions in both groups was recorded. RESULTS The total effective rate （91.44% vs. 81.48%） and infant live birth rate （96.30% vs. 83.33%） of the study group were significantly higher than those of the control group （P＜0.05）. Following treatment， various TCM syndrome scores and total score， spiral artery RI and PI levels in both groups were markedly lower than those in the same groups before treatment， with the study group showing significantly lower levels than the control group（P＜0.05）. Conversely， the P， E2， HCG and EST levels in both groups were significantly higher than those in the same groups before treatment， and the study group exhibited notably higher levels than the control group （P＜0.05）. There was no statistically significant difference in the total incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS PRP intrauterine infusion combined with Gushen antai pills has good clinical efficacy in the treatment of RSA. It can improve TCM syndromes， enhance endometrial receptivity， regulate hormone levels and improve pregnancy outcomes， and it is highly safe.

Atherosclerosis(AS)is a chronic inflammatory disease involving disorders of lipid and iron metabolism.The establishment of suitable animal models is required to further the study of the etiology,pathogenesis,prevention,and therapeutic measures of AS.The main animal models of AS related to iron and lipid metabolism are mice and miniature piglets,especially male ApoE-/-mice.Single-factor high-fat diet-induced iron and lipid metabolism disorders are a common type of AS model,manifesting as elevated blood lipid levels,large plaques and iron deposition in the aorta,and significant increases in serum and liver iron levels.This review compares the effects of different intervention factors on iron and lipid metabolism in AS animal models,and summarizes the method of establishing AS animal models using dietary induction,chemical intervention,and gene modification,to provide references and inspiration for future research into AS and metabolic diseases and the development of new drugs.

Objective:To construct the risk prediction model for early-onset peritoneal dialysis-associated peritonitis (PDAP) in peritoneal dialysis patients based on six machine learning algorithms.Methods:This study was retrospective. Convenience sampling was used to select peritoneal dialysis patients who were regularly followed up in the Department of Nephrology of Guizhou Provincial People's Hospital from December 2009 to August 2023 to collect general information, primary diseases, and laboratory indicators of the study population. It was randomly divided into a modeling set and validation set in the ratio of 7∶3. With the occurrence of early-onset PDAP as the dependent variable, the risk prediction model of early-onset PDAP in peritoneal dialysis patients was constructed based on six machine learning algorithms, namely, Logistic regression, decision tree, support vector machine, random forest, extreme gradient boosting, and artificial neural network, respectively. Model performance was evaluated based on the area under the receiver operating characteristic curve ( AUC) , accuracy, and F1 score to select the optimal model. Results:The final data of 890 peritoneal dialysis patients were analyzed, of which 86 patients developed early-onset PDAP, and the incidence of early-onset PDAP was 9.66%. The four prediction models, Logistic regression, support vector machine, extreme gradient boosting, and random forest, had high accuracy with AUC values of 0.703, 0.729, 0.782, and 0.814, respectively, with the random forest model having higher AUC value, accuracy, and F1 score. Further ranking of the importance of risk factors for early-onset PDAP based on the random forest model showed that the top five characteristic variables were C-reactive protein, triglycerides, platelet, ferritin, and leukocyte, in that order. Conclusions:The risk prediction model for early-onset PDAP in peritoneal dialysis patients constructed based on the random forest model has optimal performance, which can help medical and nursing staff assess and prevent early-onset PDAP at an early stage.

Atherosclerosis(AS)is a chronic inflammatory disease involving disorders of lipid and iron metabolism.The establishment of suitable animal models is required to further the study of the etiology,pathogenesis,prevention,and therapeutic measures of AS.The main animal models of AS related to iron and lipid metabolism are mice and miniature piglets,especially male ApoE-/-mice.Single-factor high-fat diet-induced iron and lipid metabolism disorders are a common type of AS model,manifesting as elevated blood lipid levels,large plaques and iron deposition in the aorta,and significant increases in serum and liver iron levels.This review compares the effects of different intervention factors on iron and lipid metabolism in AS animal models,and summarizes the method of establishing AS animal models using dietary induction,chemical intervention,and gene modification,to provide references and inspiration for future research into AS and metabolic diseases and the development of new drugs.

Ferroptosis is a form of iron-dependent cell death caused by a disorder of iron lipid metabolism.Its mechanism mainly includes lipid metabolism and iron metabolism,which are complicated and strictly regulated by various metabolic and signaling pathways.Current studies have shown that ferroptosis is associated with cancer,atherosclerosis,and neurological diseases.Traditional Chinese medicine(TCM)is characterized by various active ingredients,relatively high safety,and lower treatment costs,which possess unique advantages in clinical applications.It has been widely used in the treatment of various diseases.Taking the regulation of ferroptosis by traditional Chinese medicine as the entry point may be a new direction for the future prevention and treatment of various diseases.In this review,we discussed the mechanism of iron lipid metabolic disorders based on ferroptosis and the research progress of traditional Chinese medicine intervention to provide reference and treatment strategies for the prevention and treatment of related diseases.

Objective:To analyze the clinical and genetic characteristics of five patients with familial male-limited precocious puberty(FMPP).Methods:The clinical data, laboratory and imaging results of the five patients with FMPP were collected. Whole exome sequencing was carried out to identify the potential variants. Suspected variants were verified by Sanger sequencing of family numbers.Results:Of the five patients, four were children and one was an adult. All the four children presented to hospital with premature sexual development at age less than 4 years. Serum testosterone was elevated, luteinizing hormone(LH) and follicle stimulating hormone(FSH) basal values were at prepubertal levels, and gonadotropin-releasing hormone(GnRH) stimulation test suggested peripheral precocious puberty. Genetic analysis revealed the mutations of LHCGR genes in all the five patients. Patients 1, 2, 3, and 4 carried the same heterozygous mutation c. 1713G>C(p.M571I), and the patient 5 carried the c. 1741T>C(p.C581R)variation. The four children were treated with anti-androgen preparations and the third-generation aromatase inhibitors, all of which were effective.Conclusion:The c. 1713G>C mutation of LHCGR gene is a novel one which expands the mutation spectrum of LHCGR gene. Combined treatment with bicaluamide and the third generation aromatase inhibitors can improve clinical symptoms and delay epiphyseal closure in children with FMPP.

Objective: To investigate the value of single nucleotide polymorphism array (SNP-array) for fetuses with abnormal ultrasound findings. Method: A total of 904 fetuses with abnormal ultrasound findings were enrolled in this study from May 2015 to November 2017, and 434 (48.0%) cases received conventional karyotyping analysis at the same time. According to different abnormal ultrasound category, 904 cases were divided into 5 groups: 280 cases (31.0%) in single system structural anomalies, 31 cases (3.4%) in multiple system structural anomalies, 331 cases (36.6%) in single ultrasound soft marker abnormalities without structural anomalies, 107 cases (11.8%) in multiple soft marker abnormalities and 155 cases (17.2%) in structural abnormalities combined with soft markers abnormalities. Abnormal detection rates by SNP-array among 5 groups of abnormal ultrasound category were calculated. Result: (1) Total SNP-array results: 171 (19.0%) cases out of 904 cases analyzed by SNP-array, presented chromosomal abnormalities. Pathogenic copy number variants were detected in 27 cases (3.0%) and variants of unknown significance were detected in 81 cases (7.8%) . In addition, 7 cases (26.0%) were found with new mutation by parental validation. (2) SNP-array of 5 groups: among the 5 groups of abnormal ultrasound category, chromosomal abnormalities were identified by SNP-array in 19.3% (54/280) with single system structural abnormalities, 25.8% (8/31) with multiple system structural abnormalities, 13.9% (46/331) with single nonstructural anomalies, 19.6% (21/107) with multiple nonstructural anomalies and 27.1% (42/155) with structural abnormalities combined with nonstructural anomalies. The differences were significant (P=0.010) . No chromosome abnormalities was identified in single soft marker abnormalities, such as choroid plexus cysts, echogenic foci in the heart, single umbilical artery and pyelectasis. (3) Chromosomal abnormalities: the abnormal detection rate of aneuploidy chromosomal abnormalities by SNP-array increased with the maternal age, decreased with the gestational weeks (all P<0.05) . However, the pathogenic copy number variants and variants of unknown significance rates did not change with maternal age and gestational weeks (all P>0.05) . (4) SNP-array and karyotyping: 434 cases were analyzed by conventional karyotyping and SNP-array respectively, 10.3% (43/419) of which presented chromosomal abnormalities by conventional karyotyping and 18.7% (81/434) of which presented chromosomal abnormalities by SNP-array. Conclusions SNP-array could be a useful genetic analysis method in prenatal diagnosis for fetuses with abnormal ultrasound findings. For different abnormal ultrasound category, SNP-array has different detection rate. Compared with conventional karyotyping analysis, SNP-array can improve the detection rates for chromosomal abnormalities and find the chromosome abnormalities which can′t be detected by conventional karyotyping analysis. In clinical prenatal genetic counseling, SNP-array should be selected rationally in combination with the various abnormal ultrasound category.