Objective:To compare the clinical efficacy of three-in-one procedure versus combined anterior cruciate ligament (ACL) and anterolateral structure (ALS) reconstruction in patients with ACL reconstruction failure.Methods:A total of 32 patients who underwent revision ACL reconstruction from January 2020 to March 2023 were included. The ipsilateral semitendinosus tendon, gracilis tendons, and the anterior half of the ipsilateral peroneus longus tendon, were harvested to constitute the autograft. In patients in whom the ipsilateral semitendinosus and gracilis tendons were unavailable, the bilateral anterior halves of the peroneus longus tendons were utilised. The ACL+ALS group, with bigger transplant graft (diameter >8 mm, n=17; males 13, females 4; mean age 28.29±7.90 years), ACL combined with ALS reconstruction were performed. The three-in-one group ( n=15; males 8, females 7; mean age 29.53±6.73 years) underwent additional iliotibial band (ITB) transposition for grafts with diameter <8 mm (excluding ITB). Operative time, intraoperative blood loss, and graft dimensions were compared. Graft healing was evaluated via postoperative MRI. Knee stability was evaluated via the Lachman test. Lysholm knee score, International Knee Documentation Committee (IKDC) score, knee injury and osteoarthritis outcome score (KOOS), and Tegner activity scale were compared preoperatively, 6-months postoperatively, and 12-months postoperatively, to assess knee function recovery. Results:Surgical parameters revealed that the ACL+ALS group had an operative time of 47.82±9.32 min, blood loss of 29.00±6.99 ml, graft diameter of 8.77±0.69 mm; three-in-one group had an operative time of 57.47±10.06 min, blood loss of 36.33±6.99 ml, graft diameter of 8.53±0.52 mm. Although graft diameter showed no significant intergroup difference ( t=1.065, P>0.05), the three-in-one group showed significantly longer operative times and greater blood loss ( t=2.815, P=0.009; t=2.746, P=0.010). The average follow-up time of the ACL+ALS group was 19.47±5.25 months (range, 12-28 months), whereas the three-in-one group was 20.40±6.50 months (range, 12-32 months). Postoperative MRI showed continuous and homogeneous graft signals in both groups at 6 and 12 months. Lachman test showed negative in 15 cases, grade I in 2 cases in the ACL+ALS group; and negative in 14 cases, grade I in 1 case in the three-in-one group. Both groups exhibited significant improvement from preoperative status ( P<0.001), with no intergroup difference ( P=1.000). Functional scores revealed that both groups showed significant improvement in Lysholm, IKDC, and Tegner scores at 6 and 12 months ( P<0.05 vs. preoperative), with no intergroup differences ( P>0.05). In KOOS subscales, the three-in-one group had significantly lower scores than the ACL+ALS group in pain (88.89±5.75 vs. 94.77±3.79 at 6 months; 89.26±5.93 vs. 96.41±3.22 at 12 months) and sports/recreation (71.33±12.32 vs. 83.53±9.31 at 6 months; 73.67±13.43 vs. 88.24±8.65 at 12 months; P<0.05). Conclusions:When the graft diameter is greater than or equal to 8 mm, both the three-in-one procedure and ACL combined with ALS reconstruction are effective for revision ACL reconstruction. However, patients who underwent three-in-one procedure experienced higher postoperative pain levels.

BACKGROUND:Cervical spondylosis is a chronic degenerative disease that has become one of the most common and frequent diseases threatening human health.At present,the initial diagnosis of the cervical spine and its surrounding structures mainly relies on the interpretation of medical images by radiologists,which not only requires a high level of technical requirements for operators,but also has the disadvantages of strong subjectivity,high labor intensity,and low efficiency.With the rapid development of artificial intelligence technology,its powerful data processing and image recognition capabilities have shown broad application prospects in the medical field.Deep learning has also made certain progress in the research of spinal diseases.OBJECTIVE:To summarize the current status and research progress in the application of artificial intelligence technology in cervical spine imaging images in recent years,evaluating the performance of artificial intelligence models as well as future trends and challenges to be overcome.METHODS:The first author searched the relevant articles in WanFang,CNKI,and PubMed in June 2024.The Chinese search terms were"artificial intelligence,deep learning,cervical spine."English serach terms were"artificial intelligence,Al,cervical vertebrae,cervical."Finally,101 articles were included and analyzed.RESULTS AND CONCLUSION:(1)Artificial intelligence technology can realize automatic segmentation of cervical vertebrae and measurement of curvature change by segmentation,classification,landmarks recognition of medical image parts,detect cervical vertebral fracture,nerve root,and spinal cord type cervical spondylosis,identify cervical spine ossification of posterior longitudinal ligament,and predict post-surgery related risk factors and cervical vertebra maturation classification.(2)Although artificial intelligence technology has shown great potential in the field of cervical spine research,it is still in the early stages of exploration and rapid development,with unlimited room for development and innovation.

Objective:To investigate the interventional effect of Rhizoma Corydalis on mice with ulcerative colitis(UC)induced by dextran sulfate sodium(DSS),as well as the potential mechanism of Rhizoma Corydalis in the treatment of UC based on metabolomics and inflammation biomarkers.Methods:A mouse model of UC was established,and then the mice were divided into model group,high-dose group(1.517 g/kg crude drug),middle-dose group(0.986 g/kg crude drug),low-dose group(0.455 g/kg crude drug),and positive drug group(5-aminosalicylic acid at a dose of 718.8 mg/kg),while the mice without modeling were selected as normal group(0.9%NaCl by gavage).The mice in each group were administered for 7 consecutive days,and phenotypic parameters were dynamically moni-tored,such as body weight change,disease activity index(DAI),mean daily food intake,and daily water intake.The mice were sacri-ficed after 7 days to collect serum and colon tissue samples;ELISA was used to measure the serum levels of the proinflammatory fac-tors interleukin-6(IL-6),interleukin-17A(IL-17A),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α),and ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS)was used to perform the non-targeted metabolomics analysis and compare the differences in se-rum metabolite profiles between groups.The mice were selected for modeling and validation with the same method,and glutathione(GSH)was selected as the positive drug.Colon length and mucosal damage were assessed,and quantitative real-time PCR was used to measure the relative mRNA expression levels of the key genes in the glutathione synthesis pathway(γ-glutamylcysteine synthetase[γ-GCS]and oxidative stress regulators yap1p and skn7)and mito-chondrial GSH transporter protein(Slc25a39)in colonic tissue.Results:Rhizoma Corydalis significantly improved weight loss,DAI,and colon length in a dose-dependent manner in the model animals,and there were reductions in the serum levels of IL-6,CRP,and TNF-α,while it had no significant effect on IL-17A.The metabolomics analysis revealed 21 potential biomarkers associated with amino acid and lipid metabolism,which were significantly regulated by Rhizoma Corydalis.In the verification experiment,both Rhi-zoma Corydalis and GSH exerted a significant protective effect against colonic mucosal damage without affecting colon length.Rhizoma Corydalis upregulated the expression of genes associated with glutathione synthesis,especially γ-GCS,suggesting that Rhizoma Co-rydalis could enhance intestinal antioxidant defenses.Conclusion:Rhizoma Corydalis has a therapeutic potential in a mouse model of DSS-induced UC and can alleviate symptoms,reduce the serum levels of inflammatory markers,and regulate metabolic pathways,and upregulation of the genes associated with glutathione synthesis suggests that the drug can enhance intestinal antioxidant defenses.

Objective:To compare the clinical efficacy of three-in-one procedure versus combined anterior cruciate ligament (ACL) and anterolateral structure (ALS) reconstruction in patients with ACL reconstruction failure.Methods:A total of 32 patients who underwent revision ACL reconstruction from January 2020 to March 2023 were included. The ipsilateral semitendinosus tendon, gracilis tendons, and the anterior half of the ipsilateral peroneus longus tendon, were harvested to constitute the autograft. In patients in whom the ipsilateral semitendinosus and gracilis tendons were unavailable, the bilateral anterior halves of the peroneus longus tendons were utilised. The ACL+ALS group, with bigger transplant graft (diameter >8 mm, n=17; males 13, females 4; mean age 28.29±7.90 years), ACL combined with ALS reconstruction were performed. The three-in-one group ( n=15; males 8, females 7; mean age 29.53±6.73 years) underwent additional iliotibial band (ITB) transposition for grafts with diameter <8 mm (excluding ITB). Operative time, intraoperative blood loss, and graft dimensions were compared. Graft healing was evaluated via postoperative MRI. Knee stability was evaluated via the Lachman test. Lysholm knee score, International Knee Documentation Committee (IKDC) score, knee injury and osteoarthritis outcome score (KOOS), and Tegner activity scale were compared preoperatively, 6-months postoperatively, and 12-months postoperatively, to assess knee function recovery. Results:Surgical parameters revealed that the ACL+ALS group had an operative time of 47.82±9.32 min, blood loss of 29.00±6.99 ml, graft diameter of 8.77±0.69 mm; three-in-one group had an operative time of 57.47±10.06 min, blood loss of 36.33±6.99 ml, graft diameter of 8.53±0.52 mm. Although graft diameter showed no significant intergroup difference ( t=1.065, P>0.05), the three-in-one group showed significantly longer operative times and greater blood loss ( t=2.815, P=0.009; t=2.746, P=0.010). The average follow-up time of the ACL+ALS group was 19.47±5.25 months (range, 12-28 months), whereas the three-in-one group was 20.40±6.50 months (range, 12-32 months). Postoperative MRI showed continuous and homogeneous graft signals in both groups at 6 and 12 months. Lachman test showed negative in 15 cases, grade I in 2 cases in the ACL+ALS group; and negative in 14 cases, grade I in 1 case in the three-in-one group. Both groups exhibited significant improvement from preoperative status ( P<0.001), with no intergroup difference ( P=1.000). Functional scores revealed that both groups showed significant improvement in Lysholm, IKDC, and Tegner scores at 6 and 12 months ( P<0.05 vs. preoperative), with no intergroup differences ( P>0.05). In KOOS subscales, the three-in-one group had significantly lower scores than the ACL+ALS group in pain (88.89±5.75 vs. 94.77±3.79 at 6 months; 89.26±5.93 vs. 96.41±3.22 at 12 months) and sports/recreation (71.33±12.32 vs. 83.53±9.31 at 6 months; 73.67±13.43 vs. 88.24±8.65 at 12 months; P<0.05). Conclusions:When the graft diameter is greater than or equal to 8 mm, both the three-in-one procedure and ACL combined with ALS reconstruction are effective for revision ACL reconstruction. However, patients who underwent three-in-one procedure experienced higher postoperative pain levels.

Objective:To analyze the present status and problems for management services in a public hospital, and explore the strategies to enhance the performance of hospital management services drawing on the experience of the reforms to streamline administration and delegate power, improve regulation, and upgrade services in the public service sector.Methods:In June 2023, a convenience sampling method was employed to select staff from all clinical departments, medical technology departments, and administrative units within a tertiary public hospital as survey participants. An anonymous online questionnaire was conducted to assess overall satisfaction with hospital management services, satisfaction with the " one-stop" service windows, satisfaction with individual administrative departments, and to gather suggestions for improving hospital management services. The Likert 5-level scoring method was used to evaluate the satisfaction. Suggestions and opinions were categorized and analyzed based on the three dimensions of the reforms to streamline administration and delegate power, improve regulation, and upgrade services.Results:A total of 962 valid questionnaires were collected. The overall satisfaction score for hospital management service was 4.40±0.89 points, with interdepartmental collaboration scoring the lowest score at 4.26±0.99 points. Information management, outpatient services, and research management processes were identified as areas requiring optimization, each mentioned over 100 times. Excessive and overly frequent inspection and evaluations, as well as documentation requirements were the most prominent manifestations of formalism and bureaucracy within administrative units. The average satisfaction score for the " one-stop" service windows was 4.59±0.68 points, and unclear service guidelines/processes and incomplete information provided by window staff were the primary causes of multiple return visits. The average satisfaction score of 32 administrative units was 4.53±0.09 points. A total of 322 valid suggestions were collected, with 13.35% concerning " streamline administration and delegate power", 28.58% addressing " improve regulation", and 58.07% focused on " upgrade services" .Conclusions:Staff at the hospital expressed overall satisfaction with the institution′s management services, but noted areas for improvement in departmental coordination, management of operational processes, and the implementation of the " one-stop service" initiative, and so on. Hospitals should optimize the following aspects: improving " upgrade services" as the primary task and important approach, focusing on building a service-oriented management culture; adhering to the " improve regulation", establishing and improving the modern hospital management system; deepening the " streamline administration and delegate power", transforming management styles and simplifying approval interventions.

BACKGROUND:Cervical spondylosis is a chronic degenerative disease that has become one of the most common and frequent diseases threatening human health.At present,the initial diagnosis of the cervical spine and its surrounding structures mainly relies on the interpretation of medical images by radiologists,which not only requires a high level of technical requirements for operators,but also has the disadvantages of strong subjectivity,high labor intensity,and low efficiency.With the rapid development of artificial intelligence technology,its powerful data processing and image recognition capabilities have shown broad application prospects in the medical field.Deep learning has also made certain progress in the research of spinal diseases.OBJECTIVE:To summarize the current status and research progress in the application of artificial intelligence technology in cervical spine imaging images in recent years,evaluating the performance of artificial intelligence models as well as future trends and challenges to be overcome.METHODS:The first author searched the relevant articles in WanFang,CNKI,and PubMed in June 2024.The Chinese search terms were"artificial intelligence,deep learning,cervical spine."English serach terms were"artificial intelligence,Al,cervical vertebrae,cervical."Finally,101 articles were included and analyzed.RESULTS AND CONCLUSION:(1)Artificial intelligence technology can realize automatic segmentation of cervical vertebrae and measurement of curvature change by segmentation,classification,landmarks recognition of medical image parts,detect cervical vertebral fracture,nerve root,and spinal cord type cervical spondylosis,identify cervical spine ossification of posterior longitudinal ligament,and predict post-surgery related risk factors and cervical vertebra maturation classification.(2)Although artificial intelligence technology has shown great potential in the field of cervical spine research,it is still in the early stages of exploration and rapid development,with unlimited room for development and innovation.

Objective:To analyze the present status and problems for management services in a public hospital, and explore the strategies to enhance the performance of hospital management services drawing on the experience of the reforms to streamline administration and delegate power, improve regulation, and upgrade services in the public service sector.Methods:In June 2023, a convenience sampling method was employed to select staff from all clinical departments, medical technology departments, and administrative units within a tertiary public hospital as survey participants. An anonymous online questionnaire was conducted to assess overall satisfaction with hospital management services, satisfaction with the " one-stop" service windows, satisfaction with individual administrative departments, and to gather suggestions for improving hospital management services. The Likert 5-level scoring method was used to evaluate the satisfaction. Suggestions and opinions were categorized and analyzed based on the three dimensions of the reforms to streamline administration and delegate power, improve regulation, and upgrade services.Results:A total of 962 valid questionnaires were collected. The overall satisfaction score for hospital management service was 4.40±0.89 points, with interdepartmental collaboration scoring the lowest score at 4.26±0.99 points. Information management, outpatient services, and research management processes were identified as areas requiring optimization, each mentioned over 100 times. Excessive and overly frequent inspection and evaluations, as well as documentation requirements were the most prominent manifestations of formalism and bureaucracy within administrative units. The average satisfaction score for the " one-stop" service windows was 4.59±0.68 points, and unclear service guidelines/processes and incomplete information provided by window staff were the primary causes of multiple return visits. The average satisfaction score of 32 administrative units was 4.53±0.09 points. A total of 322 valid suggestions were collected, with 13.35% concerning " streamline administration and delegate power", 28.58% addressing " improve regulation", and 58.07% focused on " upgrade services" .Conclusions:Staff at the hospital expressed overall satisfaction with the institution′s management services, but noted areas for improvement in departmental coordination, management of operational processes, and the implementation of the " one-stop service" initiative, and so on. Hospitals should optimize the following aspects: improving " upgrade services" as the primary task and important approach, focusing on building a service-oriented management culture; adhering to the " improve regulation", establishing and improving the modern hospital management system; deepening the " streamline administration and delegate power", transforming management styles and simplifying approval interventions.

ObjectiveThis study aims to understand the recognition of practitioners in traditional Chinese medicine （TCM） hospitals on hospital-based health technology assessment （HB-HTA）， assessment needs， challenges， and suggestions， so as to provide references for the future work. MethodThe convenient sampling method was adopted to survey the relevant practitioners in TCM hospitals. The questionnaire included 39 questions in 4 dimensions and was distributed through the online platform Weijuanxing. ResultA total of 244 questionnaires were recovered， and the obtained data were analyzed in SPSS. The results showed that 137 practitioners were very familiar with HB-HTA and there was no significant difference in the recognition of practitioners in different occupations （F=0.251； P=0.778）. The practitioners in Hong Kong， Macao， and Taiwan had lower recognition than those in other regions. In terms of the assessment needs， 127 practitioners believed that it was very necessary to carry out HB-HTA in TCM hospitals in the future. Chinese patent medicines/Chinese herbal medicine decoction pieces （5.91） and TCM appropriate technology （5.57） had higher assessment priority scores. The assessment needs were high for the effectiveness （235 practitioners） and safety （224 practitioners） of health technology. The lack of specialized organization and standardized evaluation process system and the shortage of talents were considered to be the major challenges for the future development in this field. ConclusionThe stakeholders carrying out the health technology assessment in TCM hospitals had certain awareness of HB-HTA. Most practitioners believed that it was necessary to carry out HB-HTA in TCM hospitals in the future， while the work might face challenges such as the lack of organizations and system and the shortage of talents， which requires policy support.

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become an increasingly important health challenge, with a substantial rise linked to changing lifestyles and global obesity. Ursolic acid, a natural pentacyclic triterpenoid, has been explored for its potential therapeutic effects. Given its multifunctional bioactive properties, this research further revealed the pharmacological mechanisms of ursolic acid on MASLD. Methods: Drug target chips and bioinformatics analysis were combined in this study to explore the potential therapeutic effects of ursolic acid on MASLD. Molecular docking simulations, surface plasmon resonance analyses, pull-down experiments, and co-immunoprecipitation assays were used to verify the direct interactions. Gene knockdown mice were generated, and high-fat diets were used to validate drug efficacy. Furthermore, initial CD4+ T cells were isolated and stimulated to demonstrate our findings. Results: In this study, the multifunctional extracellular matrix phosphorylated glycoprotein secreted phosphoprotein 1 (SPP1) was investigated, highlighting its capability to induce Th17 cell differentiation, amplifying inflammatory cascades, and subsequently promoting the evolution of MASLD. In addition, this study revealed that in addition to the canonical TGF-β/IL-6 cytokine pathway, SPP1 can directly interact with ITGB1 and CD44, orchestrating Th17 cell differentiation via their joint downstream ERK signaling pathway. Remarkably, ursolic acid intervention notably suppressed the protein activity of SPP1, suggesting a promising avenue for ameliorating the immunoinflammatory trajectory in MASLD progression. Conclusions Ursolic acid could improve immune inflammation in MASLD by modulating SPP1-mediated Th17 cell differentiation via the ERK signaling pathway, which is orchestrated jointly by ITGB1 and CD44, emerging as a linchpin in this molecular cascade.

We retrospectively analyzed therapy efficacy and the adverse reactions of 10 patients suffering from systemic lupus erythematosus (SLE) with intestinal involvement treated with rituximab (RTX). Patients were hospitalized in the Department of Rheumatology and Immunology of the First Medical Center of PLA General Hospital from January 2015 to January 2023. Among the 10 patients, two were men and eight were women. The age of the cohort was (41.9±8.8) years. The age at disease onset was (28.8±9.2) years. The total course of the SLE diagnosis was(109.6±59.9) months. The course of the diagnosis of SLE with intestinal involvement was (89.3±50.2) months. The time from the appearance of intestinal symptoms to the diagnosis of SLE with intestinal involvement was 1.5 (1.0,8.0) months. The time from the diagnosis of SLE with intestinal involvement to RTX use was 13.0 (1.0,46.3) months. Follow-up duration after application of RTX treatment was (55.3±28.4) months. There were five cases of abdominal pain, four cases of abdominal distension, nine cases of diarrhea, three cases of nervous-system involvement, nine cases of lupus nephritis, and seven cases of serositis. All 10 patients underwent computed tomography and radiology of the abdomen. Eight patients had intestinal-wall edema, seven suffered intestinal dilation, four had target signs, three suffered congestion of mesenteric blood vessels, eight had increased mesenteric-fat density, and six had false intestinal obstruction. All 10 patients showed a low level of complement C3 (250-750 mg/L). Nine cases showed a low level of complement C4 (10-90 mg/L). The SLE disease activity index 2000 (SLEDAI-2K) at baseline in 10 patients was 20.5 (17.8, 30.0). After receiving RTX (0.5 g: day 1, day 14, or 375 mg/m 2: day 1, day 14) induction treatment, the intestinal symptoms of 10 cases were relieved completely. Four patients had adverse reactions, of which three received a high-dose glucocorticoid combined with RTX treatment simultaneously. Adverse reactions manifested mainly as a reduced level of IgG and infection with herpes simplex virus in one case, reduced level of IgG and lung infection in one patient, lung infection in one case, and reduced IgG level in one patient. RTX may an efficacious treatment strategy for patients suffering from refractory SLE with intestinal involvement.