Objective: To evaluate the diagnostic performance of magnetic resonance spectroscopy (MRS) in discriminating fumarate hydratase-deficient (FH-d) uterine leiomyomas (ULs) from FH-preserved ULs. Materials and Methods: This study consisted of three stages, with independent cohorts recruited for each stage: 1) sample-size estimation was retrospectively performed on UL specimens (diameter ≥3 cm; age, 20–40 years) from our database with immunohistochemistry (IHC) for 2-succinocysteine (2-SC) as the reference, without genetic testing, 2) MRS sequence optimization in confirmed FH germline mutation participants with ultrasound-detected ULs (diameter ≥3 cm), without IHC analysis, and 3) prospective diagnostic test accuracy was evaluated in consecutive participants with ultrasound-detected ULs (diameter ≥3 cm;age, 20–40 years), using IHC for 2-SC for determining the FH status and subsequent genetic testing in those with positive 2-SC results to identify whether FH mutations were germline or somatic in origin. The choline and fumarate peaks in MRS were classified as positive, negative, or technical failure (TF). TFs were analyzed separately and excluded from the primary diagnostic accuracy calculations. T1-, T2-, and diffusion-weighted images were interpreted as hyperintense or hypointense. The enhancement rate and apparent diffusion coefficient were also acquired. Diagnostic performance was compared between MRS and various magnetic resonance imaging (MRI) features. Results: The optimal MRS parameters for the fumarate peak were echo time (TE) = 140 ms and an average of 256. Among the 360 prospective participants, 37 were confirmed to have FH-dULs. MRS showed positive fumarate peaks in 35 of 37 FH-dULs.After excluding six TFs, the positive fumarate peak on MRS showed 94.6% (35/37) sensitivity, 99.7% (316/317) specificity, and 99.2% (351/354) accuracy, all of which were significantly superior to those of other MRI features (P ≤ 0.002). Conclusion A positive fumarate peak on MRS may be a useful imaging biomarker for diagnosing FH-dULs.

Traditional Chinese Medicine(TCM)emphasizes syndrome differentiation and treatment,characterized by"maintaining the prescription if effective"and"changing the prescription if ineffective".Traditional randomized controlled trials(RCTs)are inadequate for evaluating the efficacy of dynamic treatment adjustments.The Sequential Multiple Assignment Randomized Trial(SMART)is an emerging adaptive research design that incorporates randomization at multiple stages,allowing for adjustments in subsequent interventions based on treatment responses.This approach is suitable for evaluating dynamic treatment regimens while retaining the low bias risk of traditional RCTs,making it highly promising for clinical research in TCM.This paper summarizes recent methodological advancements in SMART design,including different sample size estimation and statistical analysis methods for primary effect objectives,embedded adaptive intervention objectives,and optimization objectives,along with providing corresponding operational software.Additionally,it offers considerations for applying SMART design in TCM research,such as the selection of disease types,interventions,decision points,tailoring variables,sample size calculation,statistical methods,the importance of pilot trials,ethical considerations,and limitations.The aim is to promote the exploration and practice of this method in the field of TCM,thereby contributing to the generation of high-quality evidence-based evidence for TCM.

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.

Objective:To investigate the short-term efficacy of robotic versus laparoscopic-assisted right hemicolectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 99 patients of right colon cancer who were admitted to Tianjin Medical University General Hospital from January 2020 to December 2023 were collected. There were 50 males and 49 females, aged 69(range, 26?89)years. Of the 99 patients, 41 patients undergoing robotic-assisted right hemicolectomy were divided into the robotic group, and 58 patients undergoing laparoscopic-assisted right hemicolectomy were divided into the lapa-roscopic group. Patients received robotic-assisted or laparoscopic-assisted right hemicolectomy operated by the same major surgeon. Observation indicators:(1) propensity score matching status and com-parison of clinical data of patients between the two groups after matching; (2) intraoperative and postoperative conditions.Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶1 nearest neighbor matching method. The caliper value was set as 0.1. Results:(1) Propensity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 99 patients, 82 patients were successfully matched, with 41 cases in each of the robotic group and the laparoscopic group. After propensity score matching, the elimination of history of abdominal operation confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After propensity score matching, the operation time of the robotic group was 215(range, 130?340)minutes, the volume of intraoperative blood loss was 50(range, 10?400)mL, the number of lymph node dissected was 21(range, 5?55), the number of intensive care unit stay was 15, time to postoperative first flatus was 3(range, 1?12)days, time to postoperative first food intake was 4(range, 2?14)days, duration of postoperative hospital stay was 8(range, 5?25)days. The above indicators of the laparoscopic group were 210(range, 140?370)minutes, 50(range, 5?150)mL, 19(range, 5?34),20, 3(range, 0?9)days, 5(range, 2?10)days, 8(range, 6?17)days, respectively. There was no significant difference in the above indicators between patients of the two groups ( Z=?0.94, ?1.87, ?1.32, χ2=1.25, Z=0.13, ?0.83, ?0.65, P>0.05). There was no patient converted to open operation in the robotic group, versus 1 patient converted to open operation in the laparoscopic group, showing no significant difference between patients of the two groups ( P>0.05). There were 6 cases in the robotic group and 4 cases in the laparoscopic group with complications, showing no significant difference between the two groups ( χ2=0.46, P>0.05). Both groups of patients achieved R 0 resection and had no readmission 30 days after surgery. The hospital expense was (11.0±1.8)×10 4 yuan of the robotic group, versus (9.0±1.7)×10 4 yuan of the laparoscopic group, showing a significant difference between the two groups ( t=?5.27, P<0.05). Conclusion:Robot-assisted right hemicolectomy is non inferior to laparoscopic-assisted right hemicolectomy in safety and efficacy, but with higher hospitalization costs.

Objective:This study aimed to investigate the safety and efficacy of cadonilimab plus chemotherapy with or without bevacizu-mab in the treatment of recurrent or metastatic cervical cancer(R/M CC).Methods:A retrospective analysis was conducted on 25 patients with R/M CC who were admitted to Tianjin Medical University Cancer Institute&Hospital between August 2022 and June 2024.All patients received cadonilimab plus chemotherapy with or without bevacizumab,followed by cadonilimab as maintenance therapy.Treatment effic-acy and adverse events were comprehensively evaluated,and patients were followed up until October 2024.Results:The median follow-up duration was 18 months(range:4-26 months).The median progression-free survival(PFS)and overall survival were not reached,and the 1-year PFS rate was 77.9%.The objective response rate was 68%,while the disease control rate was 80%.Common adverse reactions in-cluded decreased white blood cell count(40%),nausea(32%),rash(24%),and anemia(24%).No treatment-related deaths occurred during the study period.Conclusions:Cadonilimab plus chemotherapy with or without bevacizumab demonstrated a high objective response rate and a favorable safety profile in patients with R/M CC.However,further studies with larger sample sizes and extended follow-up periods are needed to further validate these findings.

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.

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.

Objective:To investigate the combined application of cytology, cell block histology and immunohistochemistry to improve the diagnostic accuracy of solid pancreatic lesions in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples.Methods:The pathological data of EUS-FNA in 311 cases of solid pancreatic lesions submitted to the Second Hospital of Hebei Medical University, Shijiazhuang, China from May 2019 to September 2023 were retrospectively analyzed. The cases included pancreatic ductal adenocarcinoma (PDAC, 172 cases), solid pseudopapillary neoplasm (SPN, 12 cases), neuroendocrine tumors (PNET, 14 cases) and chronic pancreatitis (113 cases). The cytological features of smears, the histology of cell block sections and the diagnostic markers in PDAC, SPN and PNET were analyzed. The diagnostic accuracies of cytology, cell block histology/immunohistochemistry and combination of the two methods for classifying these pancreatic solid lesions were evaluated.Results:Irregular arrangement of atypical (cancer) cells, anisonucleosis and nuclear atypia were the typical cytological features of PDAC, while presence of pseudopapillae with a myxoid/hyalinized fibrovascular core and low adhesion/salt-and-pepper chromatin were diagnostic features of SPN and NET, respectively. Immunohistochemical results showed that CK7 and CK19 were the most sensitive markers of pancreatic ductal epithelia, and the diffuse strong expression of S-100P (102/111, 91.9%) and aberrant expression of p53 (80/111, 72.1%) were important immunophenotypic markers of PDAC. Various degrees of CDX2 expression could be found in 66.4% PDAC. The expression of CD10, PR, vimentin, CD99 and cyclinD1 and the aberrant expression of β-catenin were the immunophenotypic features of SPN, while the expression of CgA, Syn and CD56 were indispensable immunemarkers for the diagnosis of PNET. Overall, cytology had higher sensitivity than cell block histology (93.9% versus 82.8%) and lower specificity (92.9% versus 99.1%), while the combination of the two methods significantly improved the sensitivity to 96.9% in solid pancreatic lesions. The combination of cytology and cell block histology could significantly improve the diagnostic efficacy of EUS-FNA in PDAC.Conclusions:Integrated diagnosis based on cytology (including rapid on-site evaluation), cell block histology and immunohistochemical findings could significantly improve the diagnostic yield of EUS-FNA in classifying solid pancreatic lesions.

Objective:To explore the predictive value of triglyceride-glucose(TYG)index and triglyceride-glu-cose-body mass index(TYG-BMI)for polycystic ovarian syndrome(PCOS)combined with metabolic syndrome(MetS).Methods:Clinical data of 109 PCOS patients who visited Xingtai People's Hospital from January 1,2022 to December 31,2023 were collected as the training group.They were divided into the MetS combined group(32 cases)and the non-Mets combined group(77 cases)according to whether they were combined with MetS.U-sing univariate and multivariate Logistic regression analysis to investigate the influencing factors of PCOS com-bined with MetS,as well as the predictive value of TYG index and TYG-BMI index for PCOS combined with MetS.In addition,according to a ratio of 7∶3 between the training group and the validation group,the clinical data of 47 patients with PCOS who visited the hospital from January 1,2024 to September 30,2024 were collected as the vali-dation group to conduct external validation of the prediction model.Results:①The serum testosterone(T),lute-inizing hormone(LH),low-density lipoprotein cholesterol(LDL-C),steady-state model insulin resistance index(HOMA-IR),TYG index,and TYG-BMI index in the MetS group were higher than those in the non MetS group(P＜0.05).② Multivariate Logistic regression analysis showed that abnormal values of LH,HOMA-IR,TYG in-dex,and TYG-BMI index were influencing factors for PCOS patients with MetS(OR＞1,P＜0.05).③The area under the curve(AUC)predicted by TYG index and TYG-BMI index for PCOS combined with MetS was 0.812 and 0.763,respectively.④Constructing predictive models for TYG index,TYG-BMI index,LH,and HOMA-IR,the clinical decision curve showed a maximum net benefit rate of 0.294.The column chart model showed that the con-sistency index(C-index)for predicting the presence of MetS in PCOS patients was 0.875.⑤The external valida-tion results of the prediction model show that the AUC of the model predicting PCOS patients with MetS was 0.948.Conclusions:TYG index and TYG-BMI index can be used for predicting MetS in PCOS patients.The risk prediction model constructed with LH and HOMA-IR can visualize the risk and has ideal predictive value.

Objective:To explore the predictive value of triglyceride-glucose(TYG)index and triglyceride-glu-cose-body mass index(TYG-BMI)for polycystic ovarian syndrome(PCOS)combined with metabolic syndrome(MetS).Methods:Clinical data of 109 PCOS patients who visited Xingtai People's Hospital from January 1,2022 to December 31,2023 were collected as the training group.They were divided into the MetS combined group(32 cases)and the non-Mets combined group(77 cases)according to whether they were combined with MetS.U-sing univariate and multivariate Logistic regression analysis to investigate the influencing factors of PCOS com-bined with MetS,as well as the predictive value of TYG index and TYG-BMI index for PCOS combined with MetS.In addition,according to a ratio of 7∶3 between the training group and the validation group,the clinical data of 47 patients with PCOS who visited the hospital from January 1,2024 to September 30,2024 were collected as the vali-dation group to conduct external validation of the prediction model.Results:①The serum testosterone(T),lute-inizing hormone(LH),low-density lipoprotein cholesterol(LDL-C),steady-state model insulin resistance index(HOMA-IR),TYG index,and TYG-BMI index in the MetS group were higher than those in the non MetS group(P＜0.05).② Multivariate Logistic regression analysis showed that abnormal values of LH,HOMA-IR,TYG in-dex,and TYG-BMI index were influencing factors for PCOS patients with MetS(OR＞1,P＜0.05).③The area under the curve(AUC)predicted by TYG index and TYG-BMI index for PCOS combined with MetS was 0.812 and 0.763,respectively.④Constructing predictive models for TYG index,TYG-BMI index,LH,and HOMA-IR,the clinical decision curve showed a maximum net benefit rate of 0.294.The column chart model showed that the con-sistency index(C-index)for predicting the presence of MetS in PCOS patients was 0.875.⑤The external valida-tion results of the prediction model show that the AUC of the model predicting PCOS patients with MetS was 0.948.Conclusions:TYG index and TYG-BMI index can be used for predicting MetS in PCOS patients.The risk prediction model constructed with LH and HOMA-IR can visualize the risk and has ideal predictive value.