Diabetic foot is one of the most common and serious chronic complications in diabetic patients.With the advancement of digital healthcare,digital therapy has been gradually implemented and promoted among diabetic foot patients as an emerging tool with the advantages of safety,efficiency,and intelligence that can make up for the shortcomings of traditional diabetic foot risk assessment,health education,and self-management.This study provides an overview of digital therapeutics,summarizes its application in patients with diabetic foot,and proposes relevant recommendations,aiming to provide a reference for improving the quality of life and satisfaction of patients with diabetic foot and reducing the recurrence of diabetic foot.

Oral lichen planus (OLP) is a chronic inflammatory disease occurring in the oral mucosa. Clinically, OLP presents with various lesion morphologies, attributed to differences in host immune responses. T-helper 17 cells (Th17) are a crucial component of the cellular immune response, primarily functioning through the secretion of interleukin 17 (IL-17). IL-17 plays a dual role in the oral mucosa: on one hand, it exerts a protective effect by promoting the recruitment of neutrophils driven by chemokines, enhancing the secretion of antimicrobial peptides, and strengthening the mucosal barrier; on the other hand, it binds to target cells in the mucosal tissue, activating downstream inflammatory signaling pathways such as nuclear factor kappa-B(NF-κB) and mitogen-activated protein kinase(MAPK), thereby initiating a pro-inflammatory cascade. This process increases the secretion of pro-inflammatory factors and promotes the recruitment and activation of immune cells, exacerbating inflammation. Current research extensively explores the correlation between the Th17/IL-17 axis and the pathogenesis and progression of OLP. This paper aims to review these developments to provide a research foundation for further elucidating the immunological mechanisms of OLP. Literature review results indicate that upregulation of Th17 and IL-17 in local lesion tissues and peripheral blood of OLP patients may be a key molecular event in the development of OLP. Compared to non-erosive OLP, higher expression levels of Th17 and IL-17 in the tissues and blood of patients with erosive OLP suggest a positive correlation between Th17/IL-17 and disease severity. Clinical studies demonstrate that targeted drugs against the Th17/IL-17 axis, by directly blocking IL-17 or inhibiting the production of Th17 cells, can effectively improve mucosal damage in OLP patients, showcasing potential as a new target for immune therapy. However, whether Th17 and IL-17 influence the pathogenesis of OLP by regulating the oral microbiome remains unclear. In summary, the Th17/IL-17 axis holds potential value as a new target for the immune therapy of OLP, warranting further in-depth research into its biological functions and signaling mechanisms within the inflammatory process of OLP.

Objective:To investigate the differences in cross-frequency coupling (CFC) characteristics of electroencephalography (EEG) between narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2).Methods:A total of 23 NT1 and 31 NT2 patients were included from the Chinese Clinical Sleep Database (CCSD) between October 2022 and September 2023. All participants underwent overnight polysomnography and a multiple sleep latency test. CFC features were extracted from EEG signals during polysomnography, encompassing various combinations of sleep stages, electrode pairs, frequency bands, and coupling types. Feature selection was performed using elastic net regularization. The Spearman correlation between key CFC features and the Epworth Sleepiness Scale (ESS) scores was analyzed. Finally, a support vector classification (SVC) model was constructed to distinguish NT1 from NT2, and leave-one-out cross-validation was used to assess the generalization performance.Results:Among all coupling features during non-rapid eye movement sleep stage 1 (N1), the fronto-occipital θ-α1 and central δ-α1 couplings showed the highest absolute coefficients, reaching 1.13 and 1.10, respectively. In the NT1 group, the α1-β2 imaginary part of phase-locking value (iPLV) of the F3-C3 pair during N1 was significantly positively correlated with ESS scores ( r=0.52, P=0.012). In the machine learning classification task, the SVC model achieved an accuracy of 85% using leave-one-out cross-validation. Conclusion:The CFC features during the sleep-wake transition stage play an important role in distinguishing NT1 from NT2 and show a significant correlation with excessive daytime sleepiness (EDS) in NT1. CFC may serve as a potential biomarker for differentiating narcolepsy subtypes and provide new insights into the mechanisms and clinical evaluation of EDS.

Objective:To investigate the predictive value of anti-Müllerian hormone (AMH) on the outcome of microscopic testicular sperm extraction (micro-TESE) in patients with non-mosaic Klinefelter syndrome (KS) of the clinical data and to identify effective predictors for successful micro-TESE.Methods:A retrospective case-control study was conducted on the clinical data of 118 non-mosaic KS patients treated at the Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University between May 2018 and September 2023. Patients were divided into two groups based on whether sperm were successfully retrieved via micro-TESE: the sperm retrieved group ( n=45) and the no sperm retrieved group ( n=73). Differences between the two groups were compared, and multivariate logistic regression analysis was used to identify factors influencing sperm retrieval. Changes in testicular volume and sex hormone levels before and after surgery were also assessed. Results:The sperm retrieval rate was 38.1% (45/118). Patients in the sperm retrieved group were significantly younger [(26.93±3.80) years] than those in the no sperm retrieved group [(28.27±3.92) years, P=0.029], and the AMH level was significantly higher [0.44 (0.18, 1.13) μg/L] than that in the no sperm retrieved group [0.10 (0.03, 0.22) μg/L, P<0.001]. AMH was identified as an independent predictor of micro-TESE outcome in non-mosaic KS patients ( OR=7.867, 95% CI: 2.727-27.242, P=0.001). The area under the receiver operating characteristic curve was 0.802 (95% CI: 0.722-0.883), and the optimal reference threshold for AMH was ≥0.265 μg/L. Postoperatively, testosterone levels decreased significantly by a median of 0.27 μg/L ( P=0.019), while luteinizing hormone levels increased by a median of 2.08 U/L ( P=0.049), with a more significant decline in testosterone levels observed in the no sperm retrieved group by a median of 0.29 μg/L ( P=0.022). Conclusion:AMH can predict successful micro-TESE in non-mosaic KS patients, with higher AMH levels indicating a higher likelihood of success.

Objective:To investigate the predictive value of anti-Müllerian hormone (AMH) on the outcome of microscopic testicular sperm extraction (micro-TESE) in patients with non-mosaic Klinefelter syndrome (KS) of the clinical data and to identify effective predictors for successful micro-TESE.Methods:A retrospective case-control study was conducted on the clinical data of 118 non-mosaic KS patients treated at the Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University between May 2018 and September 2023. Patients were divided into two groups based on whether sperm were successfully retrieved via micro-TESE: the sperm retrieved group ( n=45) and the no sperm retrieved group ( n=73). Differences between the two groups were compared, and multivariate logistic regression analysis was used to identify factors influencing sperm retrieval. Changes in testicular volume and sex hormone levels before and after surgery were also assessed. Results:The sperm retrieval rate was 38.1% (45/118). Patients in the sperm retrieved group were significantly younger [(26.93±3.80) years] than those in the no sperm retrieved group [(28.27±3.92) years, P=0.029], and the AMH level was significantly higher [0.44 (0.18, 1.13) μg/L] than that in the no sperm retrieved group [0.10 (0.03, 0.22) μg/L, P<0.001]. AMH was identified as an independent predictor of micro-TESE outcome in non-mosaic KS patients ( OR=7.867, 95% CI: 2.727-27.242, P=0.001). The area under the receiver operating characteristic curve was 0.802 (95% CI: 0.722-0.883), and the optimal reference threshold for AMH was ≥0.265 μg/L. Postoperatively, testosterone levels decreased significantly by a median of 0.27 μg/L ( P=0.019), while luteinizing hormone levels increased by a median of 2.08 U/L ( P=0.049), with a more significant decline in testosterone levels observed in the no sperm retrieved group by a median of 0.29 μg/L ( P=0.022). Conclusion:AMH can predict successful micro-TESE in non-mosaic KS patients, with higher AMH levels indicating a higher likelihood of success.

Diabetic foot is one of the most common and serious chronic complications in diabetic patients.With the advancement of digital healthcare,digital therapy has been gradually implemented and promoted among diabetic foot patients as an emerging tool with the advantages of safety,efficiency,and intelligence that can make up for the shortcomings of traditional diabetic foot risk assessment,health education,and self-management.This study provides an overview of digital therapeutics,summarizes its application in patients with diabetic foot,and proposes relevant recommendations,aiming to provide a reference for improving the quality of life and satisfaction of patients with diabetic foot and reducing the recurrence of diabetic foot.

Objective:To investigate the differences in cross-frequency coupling (CFC) characteristics of electroencephalography (EEG) between narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2).Methods:A total of 23 NT1 and 31 NT2 patients were included from the Chinese Clinical Sleep Database (CCSD) between October 2022 and September 2023. All participants underwent overnight polysomnography and a multiple sleep latency test. CFC features were extracted from EEG signals during polysomnography, encompassing various combinations of sleep stages, electrode pairs, frequency bands, and coupling types. Feature selection was performed using elastic net regularization. The Spearman correlation between key CFC features and the Epworth Sleepiness Scale (ESS) scores was analyzed. Finally, a support vector classification (SVC) model was constructed to distinguish NT1 from NT2, and leave-one-out cross-validation was used to assess the generalization performance.Results:Among all coupling features during non-rapid eye movement sleep stage 1 (N1), the fronto-occipital θ-α1 and central δ-α1 couplings showed the highest absolute coefficients, reaching 1.13 and 1.10, respectively. In the NT1 group, the α1-β2 imaginary part of phase-locking value (iPLV) of the F3-C3 pair during N1 was significantly positively correlated with ESS scores ( r=0.52, P=0.012). In the machine learning classification task, the SVC model achieved an accuracy of 85% using leave-one-out cross-validation. Conclusion:The CFC features during the sleep-wake transition stage play an important role in distinguishing NT1 from NT2 and show a significant correlation with excessive daytime sleepiness (EDS) in NT1. CFC may serve as a potential biomarker for differentiating narcolepsy subtypes and provide new insights into the mechanisms and clinical evaluation of EDS.

Anterior cruciate ligament (ACL) reconstruction is a standard treatment for ACL injuries, but it has drawbacks of a low rate of return to sports and a high incidence of osteoarthritis. In recent years, research has found that the proximal ACL tissue has a healing potential after injury. For patients who meet the indications for surgical repair, primary repair of ACL can achieve therapeutic effects comparable to ACL reconstruction, showing advantages of smaller trauma and preservation of the original ligament. Therefore, this surgical approach has received renewed attention and adoption, becoming an important supplement to ACL reconstruction. This article reviews the factors leading to the failure of previous open primary repair, and analyzes the current popularity of arthroscopic ACL primary repair. Moreover, it summarizes the surgical indications, repair procedures, rehabilitation, and return to sports of ACL primary repair, hoping to promote the clinical application of this surgical approach.

Objective:To compare the arthroscopic primary repair versus reconstruction for proximal anterior cruciate ligament (ACL) tears by a meta analysis.Methods:A comprehensive computer search was performed in China National Knowledge Infrastructure, WanFang Data, Pubmed, Web of Since, The Cochrane Library for studies comparing primary ACL repair and ACL reconstruction published before August, 2023. A meta-analysis was performed using RevMan 5.4 software to compare the surgical failure rate in repair of proximal ACL tears, International Knee Documentation Committee (IKDC) score, Lysholm score, patient satisfaction score of visual analogue scale (VAS), positive rate of Lachman test, and side-to-side difference in anterior tibial translation.Results:Included in this meta analysis were 8 articles (4 randomized controlled trials and 4 cohort studies) involving 217 eligible patients undergoing primary ACL repair and 187 eligible patients undergoing ACL reconstruction. The follow-up duration for the cases in the literature ranged from 12 to 28 months. The meta analysis showed that the short-term side-to-side difference in anterior tibial translation in the primary ACL repair group was significantly larger than that in the ACL reconstruction group ( MD=0.75, 95% CI: 0.33 to 1.16, P<0.001). However, there were no significant differences between the 2 groups in IKDC score, Lysholm score, positive rate in the Lachman test, VAS patient satisfaction score, or surgical failure rate ( P>0.05). Conclusions:Compared with ACL reconstruction, arthroscopic primary ACL repair may lead to similar functional recovery and clinical outcomes in the early postoperative period (12 to 28 months). However, caution should be exercised against primary ACL repair because it is related to greater asymptomatic knee laxity.

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.