BACKGROUND:Due to the complex movement of the scapula,which is a six-degree-of-freedom activity in three-dimensional space,it is difficult to measure it accurately using traditional methods.The image and model matching technology based on dual-plane X-ray is a three-dimensional measurement method that has gradually developed and matured in recent years.Two high-speed cameras are used to project and shoot from orthogonal directions.Compared with a single perspective,this method has advantages in observation range and reduction of out-of-plane errors,and is suitable for the study of scapula kinematics.OBJECTIVE:X-ray biplane and image-model registration technology were used to explore the differences in scapular kinematics between normal individuals and patients with rotator cuff tears,providing a basis for the treatment and rehabilitation of rotator cuff tear patients.METHODS:From April 2023 to January 2024,10 patients with normal shoulders and 10 patients with rotator cuff tears who met the inclusion criteria were enrolled from Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.The subjects underwent a shoulder CT scan to create a 3D model and a local scapular coordinate system.X-ray biplane images were taken during shoulder abduction with two C-arm machines.The 2D and 3D images were registered to compare scapular kinematic differences between the two groups at 0°,15°,30°,45°,60°,75°,and 90° of abduction,including scapular rotation angle and displacement distance.RESULTS AND CONCLUSION:(1)During shoulder abduction,the scapula of both groups showed upward rotation,but the upward rotation of the rotator cuff tear group was greater than that of the control group,and the difference was significant when the abduction was 30°-90°(P＜0.01).At the same time,the scapula internal rotation of both groups gradually increased,but the rotator cuff tear group was significantly greater than the control group when the abduction was 45°-90°(P＜0.01).In addition,the anteroposterior tilt of the scapula of the two groups was significantly different when the abduction was 15°-90°(P＜0.01).The scapula posterior tilt of the control group gradually increased during abduction,while the scapula of the rotator cuff tear group tilted forward except for a slight posterior tilt at 15°-30° abduction.(2)In terms of displacement,the upward displacement of the rotator cuff tear group was less than that of the control group during abduction,and the difference was significant at 15°-90°(P＜0.05),but there was no significant difference in lateral and anterior-posterior displacement between the two groups(P＞0.05).(3)Rotator cuff tear can cause scapular dyskinesis,characterized by increased upward rotation,internal rotation,and abnormal forward tilt during shoulder abduction.Identifying and addressing scapular dyskinesis is crucial for treating rotator cuff tear.

BACKGROUND:Due to the complex movement of the scapula,which is a six-degree-of-freedom activity in three-dimensional space,it is difficult to measure it accurately using traditional methods.The image and model matching technology based on dual-plane X-ray is a three-dimensional measurement method that has gradually developed and matured in recent years.Two high-speed cameras are used to project and shoot from orthogonal directions.Compared with a single perspective,this method has advantages in observation range and reduction of out-of-plane errors,and is suitable for the study of scapula kinematics.OBJECTIVE:X-ray biplane and image-model registration technology were used to explore the differences in scapular kinematics between normal individuals and patients with rotator cuff tears,providing a basis for the treatment and rehabilitation of rotator cuff tear patients.METHODS:From April 2023 to January 2024,10 patients with normal shoulders and 10 patients with rotator cuff tears who met the inclusion criteria were enrolled from Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.The subjects underwent a shoulder CT scan to create a 3D model and a local scapular coordinate system.X-ray biplane images were taken during shoulder abduction with two C-arm machines.The 2D and 3D images were registered to compare scapular kinematic differences between the two groups at 0°,15°,30°,45°,60°,75°,and 90° of abduction,including scapular rotation angle and displacement distance.RESULTS AND CONCLUSION:(1)During shoulder abduction,the scapula of both groups showed upward rotation,but the upward rotation of the rotator cuff tear group was greater than that of the control group,and the difference was significant when the abduction was 30°-90°(P＜0.01).At the same time,the scapula internal rotation of both groups gradually increased,but the rotator cuff tear group was significantly greater than the control group when the abduction was 45°-90°(P＜0.01).In addition,the anteroposterior tilt of the scapula of the two groups was significantly different when the abduction was 15°-90°(P＜0.01).The scapula posterior tilt of the control group gradually increased during abduction,while the scapula of the rotator cuff tear group tilted forward except for a slight posterior tilt at 15°-30° abduction.(2)In terms of displacement,the upward displacement of the rotator cuff tear group was less than that of the control group during abduction,and the difference was significant at 15°-90°(P＜0.05),but there was no significant difference in lateral and anterior-posterior displacement between the two groups(P＞0.05).(3)Rotator cuff tear can cause scapular dyskinesis,characterized by increased upward rotation,internal rotation,and abnormal forward tilt during shoulder abduction.Identifying and addressing scapular dyskinesis is crucial for treating rotator cuff tear.

Objective To investigate the association of serum total testosterone(TT),free testosterone(FT),sex hormone-binding globulin(SHBG),and estradiol(E_2)with all-cause mortality rate(AMR)in males and to evaluate their predictive value. Methods Based on data from the National Health and Nutrition Examination Survey(NHANES)cycles(1999—2004 and 2013—2016),the relationships between different sex hormones and AMR was analyzed with Cox proportional hazards regression models. The dose-response relationships between different sex hormones and male AMR were assessed with restricted cubic splines(RCS). The predictive performances of different sex hormones for male AMR were compared with receiver operating characteristic(ROC)curves and the area under the curve(AUC). The survival differences across varying sex hormone levels were evaluated with Kaplan-Meier survival curves and log-rank tests. Results This study involved 3632 adult male participants with a median follow-up of 6.5 years,during which 320 AMR occurred(8.8%). Cox univariate analysis indicated that TT,FT and SHBG were risk factors for AMR(P＜0.001). Cox multivariate analysis revealed that FT and SHBG were independent risk factors for AMR(FT:HR=0.90,95%CI:0.86-0.94; SHBG:HR=1.01,95%CI:1.01-1.02). RCS revealed a U-shaped nonlinear relationship between TT,FT and AMR(P＜0.001); SHBG showed a positive dose-response relationship with AMR(P＜0.001). The AUCs of FT predicting the 5-year,10-year,and 15-year AMR were 0.78(95%CI:0.73-0.82),0.80(95%CI:0.76-0.84),and 0.84(95%CI: 0.80-0.88),respectively,significantly outperforming other indicators. Subgroup analysis revealed that FT was negatively correlated with male AMR,but this association was modulated by age,race,smoking status and diabetes status(P_(interaction)＜0.05). Kaplan-Meier survival analysis showed that different levels of TT and FT(Q1-Q4)were significantly positively correlated with survival rate(P＜0.001),while different levels of SHBG were significantly negatively correlated with survival rate,with patients in the Q4 group having the highest risk of death(P＜0.001). Conclusion Based on US NHANES,studies have shown that the FT and SHBG are independent risk factors for male AMR,and FT demonstrates greater predictive value for male AMR than TT.

Objective To investigate the effects of lncRNA/Hedgehog signaling pathway-mediated autophagy on chondrocyte function in osteoarthritis(OA).Methods Established an LPS-induced inflammatory chondrocyte model in OA chondrocytes(SW1353),and identified it through collagen Ⅱ immunofluorescence staining and toluidine blue staining,dividing the groups into Normal,LPS,LPS/lncRNA HHIP-AS1 inhibitor,and LPS/Scr groups.RT-qPCR was used to detect lncRNA HHIP-AS1 and HHIP expression in chondrocytes,Western blot was used to assess HHIP,Gli1,Gli2,LC3B-Ⅰ/Ⅱ,and p62 protein expression,TUNEL staining and flow cytometry(FC)were used to detect cell apoptosis,and immunofluorescence assay(IFA)was used to detect autophagy LC3B expression.Results When SW1 cells were treated with LPS,compared with normal chondrocytes,after LPS induction,the volume of chondrocytes increased,the number of vacuoli in the cytoplasm increased,the volume of the nucleus increased,the morphology of some cells was irregular,and the number relatively decreased.Toluidine blue staining and type Ⅱ collagen immunohistochemical staining decreased.LPS stimulation would induce cell death and autophagy.lncRNA HIP-AS1 and HHIP were upregulated(P<0.05),the key molecules of the Hedgehog signaling pathway HHIP,Gli1 and Gli2 were continuously upregulated(P<0.05),chondrocytes treated with LPS showed obvious apoptosis(P<0.05),and LC3B(green)accumulated.The biosynthesis and processing of LC3B increased(the levels of LC3B Ⅰ and Ⅱ increased),the degradation of p62 increased(P<0.05),and the lncRNA HIP-AS1 inhibitor reduced LPS-induced apoptosis of OA chondrocytes(decreased apoptosis rate)and autophagy(decreased autophagy rate of chondrocytes treated with LPS).The biosynthesis and processing of LC3B decreased(the levels of LC3B Ⅰ and Ⅱ decreased),and the degradation of p62 weakened),and the difference was statistically significant(P<0.05).Conclusion The lncRNA HHIP-AS1 may inhibit LPS-induced OA chondrocyte apoptosis and autophagy by regulating the Hedgehog signaling pathway.

Qingzao Jiufeitang is a famous classical formula for treating lung injury caused by warm and dryness， included in the Catalogue of Ancient Famous Classical Formulas（The First Batch）. By systematically organizing ancient and modern literature on this formula， this study analyzed and verified the origin， medicinal composition， original plants and processing， dosage and decoction method， efficacy and application of this formula. According to the research， Qingzao Jiufeitang was first recorded in Yimen Falyu in the Qing dynasty， and its creation was mainly inspired by the Ming dynasty physician MIAO Xiyong's idea of the moisturizing drugs with sweet flavour and cold nature. Based on the 2020 edition of the Pharmacopoeia of the People's Republic of China（hereinafter referred to as the Chinese Pharmacopoeia） and the textual research results of modern scholars on traditional Chinese herbal medicines， the botanical sources and processing methods of the herbs in this formula are basically clarified. Among them， Mori Folium， Gypsum Fibrosum， Ginseng Radix et Rhizoma， Sesami Semen Nigrum， Asini Corii Colla， Ophiopogonis Radix and Eriobotryae Folium are consistent with the 2020 edition of the Chinese Pharmacopoeia. The primary source of Glycyrrhizae Radix et Rhizoma is the dried roots and rhizomes of Glycyrrhiza uralensis， family Leguminosae， while the primary source of Armeniacae Semen Amarum is the dried mature seeds of Prunus armeniaca， family Rosaceae. It is recommended to use Gypsum Ustum， stir-fried Sesami Semen Nigrum， stir-fried Armeniacae Semen Amarum， Asini Corii Colla bead， and honey-fried Eriobotryae Folium， and the rest of the raw products. According to the conversion of ancient and modern doses， the recommended dosages are 11.19 g for Mori Folium， 9.33 g for Gypsum Fibrosum， 3.73 g for Glycyrrhizae Radix et Rhizoma， 2.61 g for Ginseng Radix et Rhizoma， 3.73 g for Sesami Semen Nigrum， 4.48 g for Ophiopogonis Radix， 2.61 g for Armeniacae Semen Amarum， 3.73 g for Eriobotryae Folium. The decoction method is to add 300 mL of water， decoct it down to 180 mL， remove the residue， and then add 2.98 g of Asini Corii Colla into the decoction. Take it warm after meals， two to three times a day. Qingzao Jiufeitang has the effects of clearing dryness and moistening the lungs， nourishing Yin and invigorating Qi. In ancient times， it was mainly used to treat stagnation and depression of various Qi， as well as paralysis， asthma and vomiting. In modern clinical practice， it is mostly used to treat diseases in respiratory system， otolaryngology， skin system and digestive system caused by warm-dry impairing lung， deficiency of both Qi and Yin. The above research results can provide a reference for the later development of Qingzao Jiufeitang.

Objective:To explore the effects of Levothyroxine Sodium (L-T4) treatment on coagulation function and adverse pregnancy outcomes in patients with hypothyroidism during pregnancy in early and mid-to-late pregnancy.Methods:A total of 120 patients with hypothyroidism during pregnancy who were treated by L-T4 in Linyi Central Hospital from Mar. 2021 to Mar. 2024 were included, and their clinical data were retrospectively analyzed. According to the gestational age of the patients at the time of treatment, 64 cases with a gestational age of <12 weeks were included in the early pregnancy group, and 56 cases with a gestational age of ≥12 weeks were included in the mid-to-late pregnancy group. The serum thyroid hormone indexes, coagulation function indexes, adverse pregnancy outcomes, and neuropsychological development of the offspring were compared between the two groups. Statistical analyses were conducted using independent/paired t-tests and chi-square tests.Results:After treatment, there were no significant differences in the thyroid hormone indexes and coagulation function indexes between the early pregnancy group and the middle and late pregnancy group ( P>0.05). The incidence of fetal growth restriction and gestational hypertension in the early pregnancy group was 10.94% (7/64) and 17.19% (11/64), and that in the middle and late pregnancy group was 26.79% (15/56) and 33.93% (19/56), respectively. The incidence in the early pregnancy group was significantly lower than that in the middle and late pregnancy group ( χ2=5.010, 4.464, P<0.05). The developmental quotient (DQ) of the offspring in the early pregnancy group at 6 months of age in various areas of neuropsychological development (social behavior, language, adaptability, fine motor skills and gross motor skills) was significantly higher than that in the middle and late pregnancy group. The DQ of the first trimester group was (97.82±7.25) points, (94.59±6.85) points, (95.87±8.02) points, (96.08±7.25) points, and (98.34±8.07) points. The DQ of the second trimester group was (92.54±7.06) points, (90.45±6.14) points, (91.01±7.51) points, (91.24±7.08) points, and (92.74±7.38) points. The DQ of the first trimester group was significantly higher than that of the second trimester group ( t=4.029, 3.466, 3.411, 3.688, 3.946, P<0.05) . Conclusion:L-T4 treatment in early or mid- to late-pregnancy patients with gestational hypothyroidism can effectively improve their thyroid hormone levels and coagulation function, but treatment in early pregnancy is beneficial to reduce the incidence of adverse pregnancy outcomes such as fetal growth restriction and alleviate the impact of the disease on the neuropsychological development of offspring.

Objective:To systematically evaluate the effect of the Dietary Approaches to Stop Hypertension (DASH) diet on common metabolic diseases.Methods:Following the PICOS framework to construct the search formula, we systematically searched the Web of science, PubMed, Cochrane Library, CNKI, Wanfang, and VIP databases for randomized controlled trials (RCTs) investigating the effect of the DASH diet on multiple metabolic indices including body weight, body mass index (BMI), fasting blood glucose, triglycerides, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in patients with metabolic disorders (e.g., obesity, diabetes mellitus, and hypertension) published both in China and abroad from 1 January 2000 to 31 December 2023. The search terms were combinations of MeSH and free-text terms, and the raw data obtained from the search were screened according to the inclusion and exclusion criteria to determine the articles that were finally included in the analysis. The differences in these metabolic indices were compared between the intervention group group (using DASH diet) and the control group. The quality of the studies was assessed quantitatively using the modified Jadad scale and qualitatively using the Risk of Bias 2 (RoB 2) tool by two reviewers independently. Data analysis was conducted using Stata 18.0 software, with the I 2 test for heterogeneity evaluation and funnel plots for qualitative assessment of publication bias. Results:A total of 13 RCTs were included, involving 1 653 participants. Meta-analysis showed that the intervention group had more favorable effects on SBP ( SMD:-0.91, 95%CI: -1.55–-0.27; Z=-2.79, P<0.005) and DBP ( SMD: -0.98, 95%CI: -1.62–-0.33; Z=-2.96, P<0.05) than the control diet. Fasting blood glucose ( SMD: 0.21, 95% CI: 0.01–0.41; Z=2.06, P=0.04) was statistically significant. There were no significant differences in body weight, BMI, fasting blood glucose, and triglyceride outcomes betweeen these two groups. Conclusions:DASH diet is effective in controlling SBP and DBP in patients with metabolic disorders and may be useful in clinical adjunctive therapy. However, current evidence does not support an independent improvement in glycolipid metabolic markers.

Purpose To explore the relationship between the proportion of HER2 low expression and clinicopatho-logical characteristics of gastric adenocarcinoma patients.Methods Clinical data from 3 779 gastric adenocarcinoma patients who underwent radical resection were collected.HER2 expression was categorized using immunohistochemistry combined with FISH,and the clinicopathological characteristics and prognosis of HER2 low expression gastric adeno-carcinoma patients were analyzed.Results Among the 3 779 gastric adenocarcinoma cases,1 251 cases(33.10％)showed HER2 low expression.Compared with HER2 negative expression,HER2 low expression patients were more likely to be older males,present with well-differentiated Lauren's intestinal-type adenocarcinoma,and have less nerve invasion.Furthermore,compared to HER2 negative expression,they showed higher Ki67 proliferation index and more advanced clinical stage.Meanwhile,compared with patients with HER2 over expression,those with low HER2 expres-sion were more likely to be younger females,present with well-differentiated Lauren's diffuse-type adenocarcinoma,and have more nerve invasion.Furthermore,compared to HER2 over expression,they showed lower Ki67 proliferation index and more advanced clinical stage.There was no significant difference in prognosis between HER2 low expression,HER2 negative,and HER2 over expression groups.Conclusion HER2 low expression have a relatively large propor-tion in gastric adenocarcinoma patients,and HER2-targeted antibody-drug conjugates may provide an effective treatment option for these patients with HER2 low expression.

An increasing number of studies have shown that there is a close relationship between Alzheimer's disease(AD)and diabetes mellitus(DM).Traditional Chinese medicine holds that"kidney yin deficiency"is the common pathogenesis of these two diseases,while modern medicine believes that their pathogenesis involves abnormal aggregation of amyloid proteins,insulin deficiency and resistance,inflammatory response,oxidative stress,and autophagy,among others.The well-known traditional Chinese medicine formula Liuwei Dihuang Pills plays a significant role in the treatment of these two diseases with the same therapeutic approach.Therefore,this article will explore the connection between Liuwei Dihuang Pills and the treatment of AD and DM from different aspects;analyze the common etiology and pathogenesis of AD and DM,and explain the mechanism of prevention and treatment of Liuwei Dihuang Pills,with the aim of providing new ideas and methods for the integrated traditional and Western medicine prevention and treatment of AD and DM in the future.

Metastasis serves as an indicator of malignancy and is a biological characteristic of carcinomas. Epithelial-mesenchymal transition (EMT) plays a key role in the promotion of tumor invasion and metastasis and in the enhancement of tumor cell aggressiveness. Prostaglandin E synthase 3 (p23) is a cochaperone for heat shock protein 90 (HSP90). Our previous study showed that p23 is an HSP90-independent transcription factor in cancer-associated inflammation. The effect and mechanism of action of p23 on lung cancer metastasis are tested in this study. By utilizing cell models in vitro and mouse tail vein metastasis models in vivo, the results provide solid evidence that p23 is critical for promoting lung cancer metastases by regulating downstream CXCL1 expression. Rather than acting independently, p23 forms a complex with RNA-binding motif protein 14 (RBM14) to facilitate EMT progression in lung cancer. Therefore, our study provides evidence for the potential role of the RBM14-p23-CXCL1-EMT axis in the metastasis of lung cancer.