ObjectiveTo investigate the associations of multiple glycolipid metabolic indicators and their cumulative abnormality burden with incident colorectal cancer risk in a general population-based prospective cohort, and to examine the mediating role of glycolipid metabolic abnormalities in the relationships between smoking, alcohol consumption, physical activity, and colorectal cancer incidence. MethodsA total of 17 897 eligible participants recruited from the Taizhou Cohort between 2011 and 2014 were included. Cox proportional hazards regression models were used to assess the associations of conventional and derived glycolipid indicators, as well as a glycolipid abnormality index constructed from total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, and insulin, with incident colorectal cancer risk. Restricted cubic spline models were applied to evaluate dose-response relationships for major indicators. Receiver operating characteristic curves were generated to compare predictive performance across indicators. Mediation analyses were conducted to assess the mediating effects of the glycolipid abnormality index on the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence. ResultsDuring a median follow-up of 11.2 years, 102 incident colorectal cancer cases were identified, with an incidence density of 51.2 per 100 000 person-years. After adjustment for potential confounders, Cox proportional hazards regression analyses showed that decreased high-density lipoprotein cholesterol was associated with a 1.74-fold higher risk of colorectal cancer (HR=1.74, 95%CI: 1.03‒2.95), elevated low-density lipoprotein cholesterol was associated with a 1.78-fold higher risk (HR=1.78, 95%CI: 1.05‒3.02), and abnormal fasting plasma glucose was associated with a 1.86-fold higher risk (HR=1.86, 95%CI: 1.15‒3.02). Triglycerides and fasting plasma glucose showed an approximately linear increasing association with colorectal cancer risk in multivariable restricted cubic spline models. The glycolipid abnormality index showed a clear gradient association with colorectal cancer risk; participants with three or more abnormal indicators had a 3.08-fold higher risk than those without abnormalities (HR=3.08, 95%CI: 1.60‒5.92). The area under the curve was 0.795, higher than that of individual glycolipid indicators and other combined indices, and gender-stratified analyses showed generally consistent patterns. Glycolipid metabolic abnormalities partially mediated the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence, with mediation proportions of 8.33%, 9.45%, and 9.04%, respectively. ConclusionGlycolipid metabolic abnormalities are associated with an increased risk of incident colorectal cancer. The glycolipid abnormality index shows an increasing relationship with colorectal cancer risk and demonstrates better discrimination, and it partially mediates the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence in the overall population.

Objective To investigate the clinical efficacy of fire dragon pot comprehensive therapy in patients with knee paralysis due to liver and kidney deficiency following total knee arthroplasty(TKA).Methods A total of 114 patients undergoing unilateral TKA were randomly assigned to two groups using a random number table.The control group(n=57)received standard enhanced recovery after surgery(ERAS)nursing care,while the intervention group(n=57)received high-frequency general massage(HGM)therapy in addition to the standard ERAS protocol.Outcomes including visual analogue scale(VAS)scores,Hamilton Anxiety Scale(HAMA)scores,Hospital for Special Surgery(HSS)knee scores,and serum levels of inflammatory markers[C-reactive protein(CRP),neutrophil count(NE),and lymphocyte count(LY)]were compared between the two groups.Results Compared with the control group,the intervention group exhibited significantly lower VAS scores at 3 days postoperatively and at discharge,reduced HAMA scores from the preoperative period through 3 days after surgery,improved HSS scores[specifically in pain,function,range of motion,stability,and total score]at 2 weeks postoperatively,and more pronounced improvements in inflammatory markers,including lower levels of CRP and NE and higher LY levels(all P<0.05).Conclusion The comprehensive moxibustion therapy using Huolongjar effectively alleviates postoperative pain following TKA,enhances joint function,reduces anxiety levels,and mitigates inflammatory responses.This intervention is safe,simple to administer,and holds promise for clinical application and wider dissemination.

Objective To investigate the clinical efficacy of fire dragon pot comprehensive therapy in patients with knee paralysis due to liver and kidney deficiency following total knee arthroplasty(TKA).Methods A total of 114 patients undergoing unilateral TKA were randomly assigned to two groups using a random number table.The control group(n=57)received standard enhanced recovery after surgery(ERAS)nursing care,while the intervention group(n=57)received high-frequency general massage(HGM)therapy in addition to the standard ERAS protocol.Outcomes including visual analogue scale(VAS)scores,Hamilton Anxiety Scale(HAMA)scores,Hospital for Special Surgery(HSS)knee scores,and serum levels of inflammatory markers[C-reactive protein(CRP),neutrophil count(NE),and lymphocyte count(LY)]were compared between the two groups.Results Compared with the control group,the intervention group exhibited significantly lower VAS scores at 3 days postoperatively and at discharge,reduced HAMA scores from the preoperative period through 3 days after surgery,improved HSS scores[specifically in pain,function,range of motion,stability,and total score]at 2 weeks postoperatively,and more pronounced improvements in inflammatory markers,including lower levels of CRP and NE and higher LY levels(all P<0.05).Conclusion The comprehensive moxibustion therapy using Huolongjar effectively alleviates postoperative pain following TKA,enhances joint function,reduces anxiety levels,and mitigates inflammatory responses.This intervention is safe,simple to administer,and holds promise for clinical application and wider dissemination.

Objective:To systematically evaluate the effects of insulin combined with metformin in the treatment of gestational diabetes mellitus(GDM)on maternal and neonatal outcomes in China,in order to provide evidence-based medical recommendations for clinical treatment.Methods:The Chinese Academic Database(CNKI),VIP Database,and Wanfang Database were searched from the establishment of the database to April 2022 for randomized controlled trials(RCTs)of insulin combined with metformin versus insulin alone in the treatment of GDM to observe the adverse outcomes for neonates.The Cochrane Collaboration was used for quality evaluation and Review Manager 5.4 software was utilized for meta-analysis.Results:A total of 51 studies were included in the meta-analysis,including 4 916 GDM patients,with 2 460 cases in the combined treatment group and 2 456 cases in insulin alone group.The meta-analysis results revealed significant reductions in rates of cesarean section(OR=0.32,95%CI:0.26-0.39),preterm birth(OR=0.26,95%CI:0.20-0.34),polyhydramnios(OR=0.27,95%CI:0.20-0.36),gestational hypertension(OR=0.25,95%CI:0.18-0.35),neonatal jaundice(OR=0.25,95%CI:0.19-0.32),neonatal hypoglycemia(OR=0.33,95%CI:0.25-0.45),macrosomia(OR=0.23,95%CI:0.17-0.30),and neonatal respiratory distress(OR=0.23,95%CI:0.16-0.34)in the combined treatment group than those in the control group(P＜0.01).Conclusions:For patients with GDM,insulin combined with metformin is significantly more effective than insulin alone in reducing the incidence of maternal and neonatal complications.This combination therapy results in improved outcomes for both mothers and infants.

Objective:To analyze and predict the future trend of the premature mortality of major chronic and non-communicable diseases in Anhui Province, evaluate the implementation of the "Healthy China 2030" Plan, and explore its influencing factors.Methods:Using data from death-cause surveillance and statistical yearbooks in Anhui, the trend prediction and analysis on influencing factors were conducted by using methods such as time series accumulation and logarithmic linear Joinpoint regression, principal component regression.Results:In Anhui, 28.10% of the deaths were premature ones, of which 84.40% were attributed to chronic and non-communicable diseases. In premature deaths attributed to chronic and non-communicable diseases, the deaths caused by malignant tumor and cardiovascular disease accounted for 45.88% and 41.65% respectively. The prediction results showed that the premature mortality of major chronic and non-communicable diseases would decrease in Anhui in the future, and by 2030, the goal in the "Healthy China 2030" Plan would be reached only in rural area. To reduce premature death, it is necessary to pay attention to the prevention and control of malignant tumor and cardiovascular disease. Men in urban area are the key population. Factors that reflect urban infrastructure had a significant impact on premature mortality of major chronic non-communicable diseases, such as garden and green space area per capita. Factors such as concentration of PM 2.5 had a negative impact on premature mortality of chronic non-communicable diseases, while factors such as garden and green space area per capita had a positive impact. Conclusions:Disease burden caused by chronic and non-communicable diseases, such as malignant tumor, exits in Anhui. Men in urban area are key population in the prevention and control of chronic and non-communicable diseases in the future.

BACKGROUND:The majority of studies on developmental dysplasia of the hip focus on hip malformations,but there are few reports on the effects of acetabular dysplasia on the spine. OBJECTIVE:To investigate the compensation of spinopelvic parameters in coronal and sagittal views in patients with developmental dysplasia of the hip,and to explore the correlation between acetabular development and spinopelvic parameters. METHODS:A total of 101 patients with developmental dysplasia of the hip admitted to the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to June 2022 were selected as the trial group,and 114 healthy subjects were selected as the control group during the same period.The spinopelvic parameters of the subjects were measured through the full-length X-ray films of the coronal and sagittal spines:lumbar lordosis,anterior pelvic tilt,thoracolumbar kyphosis,Cobb angle,and the distance between the C7 plumb line and the center sacral vertical line,sacral slope,pelvic incidence,and thoracic kyphosis.The differences in spinopelvic parameters were compared between the two groups.In addition,the differences in spinopelvic parameters in patients with unilateral,bilateral and different Crowe classifications of developmental dysplasia of the hip were compared.Pearson correlation analysis was used to explore the correlation between Sharp angle and spinopelvic parameters. RESULTS AND CONCLUSION:(1)In the sagittal view,the lumbar lordosis in the trial group was significantly lower than that in the control group(P<0.05).The pelvic tilt and kyphosis angle of the thoracolumbar segment in the trial group were significantly greater than those in the control group(P<0.05).In the coronary position,the Cobb angle and the distance between the C7 plumb line and center sacral vertical line in the trial group were significantly greater than those in the control group(P<0.05).There was no significant difference in the remaining spinopelvic parameters between the two groups(P>0.05).(2)The lumbar lordosis of patients with bilateral developmental dysplasia of the hip was significantly lower than that of patients with unilateral developmental dysplasia of the hip(P<0.05).The pelvic tilt,thoracolumbar kyphosis,Cobb angle and the distance between the C7 plumb line and center sacral vertical line in bilateral developmental dysplasia of the hip patients were significantly greater than those in unilateral developmental dysplasia of the hip patients(P<0.05).(3)The lumbar lordosis decreased with the increase of Crowe classification severity(P<0.05).The pelvic tilt increased with the severity of the Crowe classification(P<0.05).(4)Pearson correlation analysis showed that Sharp angle was negatively correlated with lumbar lordosis(P<0.05),while Sharp angle was positively correlated with anterior pelvic tilt,Cobb angle,C7 plumb line and center sacral vertical line(P<0.05).(5)It is concluded that the pelvic tilt,thoracolumbar kyphosis,Cobb angle and the distance between the C7 plumb line and center sacral vertical line increase,while lumbar lordosis decreases in developmental dysplasia of the hip patients.The degree of acetabular dysplasia was significantly correlated with lumbar lordosis,pelvic tilt,Cobb angle,C7 plumb line and center sacral vertical line.

BACKGROUND:Overactive osteoclasts disrupt bone homeostasis and play a bad role in the pathological mechanisms of related skeletal diseases,such as osteoporosis,fragility fractures,and osteoarthritis.Studies have confirmed that ellagic acid and ellagtannin have the potential to inhibit osteoclast differentiation.As their natural metabolites,urolithin A has antioxidant,anti-inflammatory,anti-proliferative and anti-cancer effects,but its effect on osteoclast differentiation and its underlying molecular mechanisms remain unclear. OBJECTIVE:To explore the effect of urolithin A on osteoclast differentiation induced by receptor activator for nuclear factor-κB ligand and its mechanism. METHODS:Mouse mononuclear macrophage leukemia cells(RAW264.7)that grew stably were cultured in vitro.Toxicity of urolithin A(0,0.1,0.5,1.5,2.5 μmol/L)to RAW264.7 cells were detected by cytotoxic MTS assay to screen out the safe concentration.Different concentrations of urolithin A were used again to intervene with receptor activator for nuclear factor-κB ligand-induced differentiation of RAW264.7 cells in vitro.Then,tartrate-resistant acid phosphatase staining and F-actin ring and nucleus staining were performed to observe its effect on the formation and function of osteoclasts.Finally,the expressions of urolithin A on upstream and downstream genes and proteins in the MAPK signaling pathway were observed by western blot and RT-qPCR assays. RESULTS AND CONCLUSION:Urolithin A inhibited osteoclast differentiation and F-actin ring formation in a concentration-dependent manner and 2.5 μmol/L had the strongest inhibitory effect.Urolithin A inhibited the mRNA expression of Nfatc1,Ctsk,Mmp9 and Atp6v0d2 and the protein synthesis of Nfatc1 and Ctsk,related to osteoclast formation and bone resorption.Urolithin A inhibited the activity of osteoclasts by downregulating the phosphorylation of p38 protein to inhibit the mitogen-activated protein kinase signaling pathway.

BACKGROUND:Studies have shown that imbalance of bone metabolism during glucocorticoid-induced osteonecrosis of the femoral head necrosis is closely related to oxidative stress. OBJECTIVE:To investigate the pathological mechanism by which oxidative stress-induced ferroptosis promote apoptosis in osteoblasts involved in steroid-induced osteonecrosis of the femoral head. METHODS:General data and serum specimens were collected from 47 patients with steroid-induced osteonecrosis of the femoral head.In addition,six femoral head specimens were collected from these patients.According to the Association Research Circulation Osseous(ARCO)staging system,serum specimens were grouped into ARCO Ⅱ,Ⅲ,and IV,while femoral head specimens were classified into ARCO Ⅲ and IV.Serum levels of malondialdehyde and superoxide dismutase 1 were measured.The protein expression of superoxide dismutase 1,glutathione peroxidase 4,Bcl-2 in the femoral head was detected and verified by Data independent acquisition(DIA)for quantitative sequencing,western blot and alkaline phosphate detection. RESULTS AND CONCLUSION:The ARCO stage of patients with steroid-induced osteonecrosis of the femoral head was independent of age,sex and necrotic side.The serum levels of malondialdehyde and superoxide dismutase 1 were higher in patients with ARCO stage Ⅲ compared with those with ARCO stage Ⅱ and IV.The results of DIA protein quantification showed that the function of differential proteins was mainly related to redox.The levels of superoxide dismutase 1,glutathione peroxidase 4,and Bcl-2 in the necrotic region were lower than in the normal region,as well as lower in ARCO stage IV than in ARCO stage Ⅲ.Western blot verified the results of DIA protein quantification.The alkaline phosphatase activity was lower in the necrotic region than in the normal region,as well as lower in ARCO stage IV than in ARCO stage Ⅲ.In the necrotic and sclerotic regions,the function of differential proteins was also related to redox,and superoxide dismutase 1,glutathione peroxidase 4,Bcl-2 protein expression and alkaline phosphatase activity were lower in the necrotic area than in the sclerotic region,as well as lower in ARCO stage IV than in ARCO stage Ⅲ.To conclude,glucocorticoids can influence the progression of steroid-induced osteonecrosis of the femoral head by upregulating oxidative stress levels,inducing osteoblast ferroptosis,and inhibiting osteogenic function.

BACKGROUND:Pelvic tilt,which is often seen in hip diseases,is also a common functional problem after total hip arthroplasty. OBJECTIVE:To investigate the mechanism of occurrence and recovery of pelvic tilt after unilateral total hip arthroplasty in patients with femoral head necrosis. METHODS:The clinical data of 100 patients with femoral head necrosis who underwent unilateral total hip arthroplasty in the Department of Femoral Head Necrosis,Bone Injury Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected retrospectively from June 2021 to February 2023.The patients were divided into three groups,namely,groups A(<2°,n=48),B(2°-3°,n=34),and C(>3°,n=18),according to the severity of pelvic tilt on postoperative 3 day.Statistical data were collected and compared between the pre-and postoperative periods of patients of these three groups in terms of the angle of the coronal plane of the pelvis tilt,the length of the gluteus medius muscles of the bilateral sides,the heights of the rotational centers of the femoral heads,the difference in the lengths of the gluteus medius muscles of the bilateral sides and the heights of the rotational centers of the femoral heads,and the ratio of changes in the angle of the pelvic tilt.Pearson correlation coefficient was used to examine the correlation between pelvic tilt angle and other indexes. RESULTS AND CONCLUSION:(1)Pelvic tilt aggravation occurred in the short term after surgery.(2)The ratio of change in pelvic tilt angle from postoperative 3 days to postoperative 1 month time period differed between the groups,with group C>group B>group A.There was a difference between group C and the other groups in the time period from postoperative 1 to postoperative 3 months,with the ratio of change being the smallest in group C.There was no difference in the ratio of change between the groups in the time period from postoperative 3 days to postoperative 3 months.(3)The difference in bilateral gluteus medius muscles decreased gradually after surgery,and there was no difference in the comparison of bilateral gluteus medius muscles in the time period from postoperative 3 months.(4)The difference between bilateral centers of rotation increased after surgery,and the difference between bilateral heights at 3 months after surgery was smaller than that before surgery.(5)The pelvic tilt angle at 3 days after surgery,the duration of the disease and the pelvic tilt angle at 3 months after surgery were significantly correlated(all P=0.000),and the difference between bilateral gluteus medius muscles before surgery and the pelvic tilt angle at 3 days after surgery was significantly correlated(P=0.006)(6)The functional pelvic tilt occurred in the patients with femoral head necrosis after total hip arthroplasty.Correction of the pelvic tilt after surgery was based on the adaptive restoration of the functional pelvic tilt angle after surgery.Functional pelvic tilt arises as a compensatory adaptation of the organism based on the short-term postoperative reconstruction of bony structures and the survival of cumulative soft tissue damage.

ObjectiveTo classify subtypes among middle-aged and elderly type 2 diabetes mellitus (T2DM) patients aged between 35‒74 years in Shanghai suburbs, to compare their characteristics and analyze incidence risk for cerebrovascular disease among these subtypes, so as to promote personalized and precise treatment of T2DM. MethodsA total of 7 792 patients with T2DM who completed a baseline survey from 2016 and 2019 were selected as the research subjects, based on the data from a natural population cohort and biobank in Shanghai suburbs. Patients were stratified by gender and clustered into subtypes using k-means method based on baseline parameters including the age at T2DM diagnosis, body mass index (BMI), fasting blood glucose, and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Patients were followed up until March 31, 2023. Multivariate Cox regression models were used to analyze the association between subtypes and incidence risk for cerebrovascular disease, and those with cerebrovascular disease within 1 year of follow-up survey were excluded from sensitivity analysis. ResultsAmong the 7 792 patients with T2DM, 3 615 were males and 4 177 were females. Stratified by gender, 4 subgroups were identified through k-means clustering analysis, namely poor blood glucose control subgroup, severe insulin-resistant subgroup, younger onset subgroup, and older onset subgroup. The median follow-up time was 4.30 years, during which 1 960 cerebrovascular disease events were observed (844 in males, 1 116 in females). After adjusting for smoking, alcohol consumption, weekly exercise, family history of diabetes mellitus, and duration of diabetes mellitus, among male patients, the incidence risk for cerebrovascular disease was lower in the younger onset subgroup (HR=0.59, 95%CI: 0.48‒0.73, P<0.001), poor blood glucose control subgroup (HR=0.81, 95%CI: 0.65‒1.00, P=0.046), and severe insulin-resistant subgroup (HR=0.61, 95%CI: 0.50‒0.75, P<0.001), compared to the older onset subgroup. While among female patients, the incidence risk for cerebrovascular disease was also lower in the younger onset subgroup (HR=0.68, 95%CI: 0.57‒0.80, P<0.001), poor blood glucose control subgroup (HR=0.73, 95%CI: 0.60‒0.89, P=0.002), and severe insulin-resistant subgroup (HR=0.72, 95%CI: 0.61‒0.85, P<0.001), compared to the older onset subgroup. Results of the sensitivity analysis were consistent with the main findings. ConclusionAmong middle-aged and elderly T2DM patients in suburban Shanghai, both male and female patients have the highest incidence risk for cerebrovascular disease in the older onset subgroup. Subtyping of T2DM patients can help to identify the high-risk populations of cerebrovascular disease.