Objective To explore the potential cuproptosis-related genes(CRGs)in patients with multiple myeloma(MM)and develop a prognostic model for improving prognosis and revealing features of the MM immune microenvironment.Methods ① Transcriptome sequencing data and clinical information were retrieved from the GSE4581 dataset in the Gene Expression Omnibus(GEO)database and the Cancer Genome Atlas-Multiple Myeloma Research Foundation(TCGA-MMRF)database.The 859 patients from the TCGA-MMRF database were assigned into a training set,and the other 414 ones from the GSE4581 dataset into a validation set.LASSO-Cox and multivariate Cox regression analyses were used to construct prognostic models and calculate risk scores.Based on the median risk score,they were categorized into high-and low-risk cohorts.Time-dependent receiver operating characteristic(ROC)and calibration curves were plotted to assess the predictive performance and accuracy of the model.The differences between the high-and low-risk cohorts were explored using Kaplan-Meier survival curve analysis and immune microenvironment correlation analysis.② RT-qPCR and Western blotting were used to verify the expression of prognostic model genes in MM cell lines and normal bone marrow single-nucleated cells,and CCK-8 assay,flow cytometry,and Western blotting were applied to verify the biological function of UBE2D1 in MM cells.Results ① LASSO-Cox and multivariate Cox regression analyses revealed that the model consisted of 4 genes,CDKN2A[HR=1.60(95%CI:1.24～2.05),P=2.5e-4],PDE3B[HR=1.33(95%CI:1.09～1.62),P=4.2e-3],UBE2D1[HR=1.65(95%CI:1.20～2.26),P=2.1e-3]and COA6[HR=1.35(95%CI:1.07～1.71),P=0.01].In the training set,the time-dependent ROC curves predicted that the area under curve(AUC)value of 1-,3-,and 5-year survival rate was 0.63,0.71,and 0.78,respectively,and in the validation set,the AUC value was 0.656,0.657,and 0.797,respectively.Calibration curve analysis showed excellent agreement in predicting 1-,3-,and 5-year prognosis.In the training set,Kaplan-Meier curves showed that patients in the high-risk cohort had a significantly shorter overall survival(OS)than the low-risk cohort[HR=2.18(95%CI:1.58～3.02),P<0.001],and in the validation set,the high-risk cohort still had a shorter OS than the low-risk cohort[HR=2.45(95%CI:1.49～4.05),P<0.001].Immune correlation analysis revealed that the ratios of immune cells,such as plasma cells and CD4+T cells were significantly lower in the high-risk cohort(P<0.05),and the risk scores were positively correlated with the expression of immune checkpoint CTLA-4,tumor-targeted therapeutic sites TNFSF4 and ENTPD1,and microenvironmental chemokines CXCL16,CCL8,and CCL16(P<0.05).② Remarkable differences were observed in the expression of all 4 prognostic model genes between the MM cell lines and normal bone marrow single-nucleated cells(P<0.05),and knockdown of UBE2D1 notably inhibited the proliferation of MM cells(P<0.05).Conclusion Our prognostic models based on CDKN2A,PDE3B,UBE2D1,and COA6 genes can predict the prognosis of MM patients.The risk scores of the genes are significantly correlated with immune infiltration in the tumor microenvironment,which providing new molecular markers for individualized therapy.

The in-depth research of artificial intelligence in the medical field has greatly improved the workflow and diagnostic ability of diagnostic radiology.This article focuses on artificial intelligence technology in the field of interventional medicine,and enumerates its potential application scenarios,including improving image analysis capabilities to assist diagnosis and predict treatment response.It also describes the challenges that need to be overcome for practical application.Finally,with the continuous development of artificial intelligence in interventional medicine,artificial intelligence will further optimize the channels of interventional medicine and bring revolutionary changes to the clinical practice of interventional medicine.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Purpose/Significance Gestational hypertension poses a serious threat to maternal health.Artificial intelligence(AI)fol-low-up and management systems contributes to the health of gestational hypertension.Method/Process The paper establishes an AI fol-low-up system for gestational hypertension based on big data technology and data platforms,including modules such as patient informa-tion management,follow-up data management,follow-up plan management,and patient course management.Result/Conclusion The follow-up system can assist doctors in understanding changes in patients'diseases and meet the hospital's follow-up management re-quirements for gestational hypertension in outpatient clinics.

Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery[anterior cervical discectomy and fusion (ACDF) + cervical disc arthroplasty ( CDA)] and three-level ACDF. Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data. Three models were simulated by the implantation of Prestige LP and Zero-P prostheses, including two Hybrid models (AFA, Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment; FAF, Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF). The changes in range of motion (ROM) of adjacent levels during flexion, extension, lateral bending and axial rotation, the overall ROM, as well as the intradiscal pressure ( IDP) and facet contact force ( FCF) of adjacent levels were compared. Results The ROM in adjacent levels and the overall ROM of the AFA modelwere closer to the intact model, and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15. 0% and 23. 4% , respectively. For AFA, FAF and FFF models, the maximum increases in the maximum IDP of adjacent levels were 19. 0% , 66. 7% , 147. 6% , and the maximum increases in FCF were 17. 4% , 55. 7% , 80. 1% , respectively. Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

Humans ; Asthma/drug therapy* ; Biological Therapy

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective:To develop a specialized clival-cervical plate fixation (CCPF) for anterior surgery to treat craniovertebral instability, and to compare it with a posterior occipitocervical fixation (POCF) in biomechanical validation.Methods:Based on the measurement of 40 adult dry bones and 30 volunteers CT images, the clival-cervical plate was designed and manufactured. 8 cadaveric specimens (occiput-C 3) were tested in five conditions including the intact status, the intact+CCPF status, the injury status, the injury+CCPF status, and the injury+POCF status. Specimens were applied a pure moment of 1.5 N·m in flexion, extension, lateral bending, and axial rotation. Calculating and comparing the range of motion (ROM) and neutral zone (NZ) for the occiput to C 2. The effects of different fixation methods on the distribution of ROMs at the occipitocervical region were compared. Results:The injury+CCPF status constrained ROMs to 1.7° in flexion ( q=4.68, P=0.055) , 1.2° in extension ( q=0.39, P=0.9922) , 2.8° in lateral bending ( q=1.25, P=0.814) , and 4.3° in axial rotation ( q=5.08, P=0.035) , resulted in larger ROM in axial rotation but similar ROMs in other directions ( P>0.05) when compared with the injury+POCF status. There were no significant differences between the above two fixation methods in flexion-extension ( q=1.94, P=0.554) , lateral bending ( q=1.79, P=0.611) and axial rotation ( q=2.14, P=0.478) for the NZs. For the flexion, extension,lateral bendingand axial rotation direction, the proportion of the C 1, 2 ROM to the overall ROM was 28%, 25%, 34% and 56% respectively in the injury+CCPF status, and it was 59%, 53%, 42% and 71% respectively in the injury+POCF status. Conclusion:CCPF is a biomechanically effective alternative or supplemental method of POCF for the craniocervical instability.

Objective:To investigate the efficacy of Yupingfeng powder combined with extensively hydrolyzed milk formulas in the treatment of milk protein allergy in infants and its effects on immune function, interleukin-10 (IL-10) and IL-22 levels. Methods:Eighty infants with milk protein allergy who received treatment in Hangzhou Children's Hospital from January 2020 to January 2021 were included in this study. They were randomly assigned to Yupingfeng powder and conventional treatment groups, with 40 infants per group. An additional 80 infants who concurrently received health examination in the same hospital were included in the control group. The conventional group was treated with extensively hydrolyzed milk formulas. The Yupingfeng powder group was treated with Yupingfeng powder combined with extensively hydrolyzed milk formulas. All infants were treated for 30 successive days. Clinical efficacy, serum total immunoglobulin (IgE), milk specific IgE (sIgE), peripheral blood CD 4+CD 25+ Treg, IL-10 and IL-22 levels were compared between groups. Results:Total response rate in the Yupingfeng powder group was significantly higher than that in the conventional treatment group [92.50% (37/40) vs. 72.50% (29/40), χ2 = 5.54, P < 0.05]. Serum total IgE and milk sIgE levels in the Yupingfeng powder group were (132.93 ± 14.61) IU/L and (0.62 ± 0.14) IU/L, respectively, which were significantly lower than (150.27 ± 16.22) IU/L and (0.85 ± 0.17) IU/L in the conventional treatment group ( t = 5.02, 6.61, both P < 0.05). The expression of CD 4+CD 25+ Treg in the Yupingfeng powder group was significantly higher than that in the conventional treatment group [(13.29 ± 1.40)% vs. (11.84 ± 1.27)%, t = 4.85, P < 0.05). CD 4+CD 25+ Treg expression in the Yupingfeng powder group was not significantly different from that in the control group [(13.40 ± 2.03)%, t = 0.31, P = 0.759]. IL-10 in the Yupingfeng powder group was significantly higher than that in the conventional treatment group [(34.57 ± 4.07) μg/L vs. (22.19 ± 2.15) μg/L, t = 17.01, P < 0.05]. IL-22 level in the Yupingfeng powder group was significantly lower than that in the conventional treatment group [(2.20 ± 0.42) ng/L vs. (5.28 ± 0.79) ng/L, t = 21.77, P < 0.05]. IL-10 and IL-22 levels in the Yupingfeng powder group were not different from those in the control group [(35.53 ± 3.85) μg/L, (2.13 ± 0.53) ng/L, t = 1.26, P = 0.209; t = 0.73, P = 0.468]. Conclusion:Yupingfeng powder combined with extensively hydrolyzed milk formulas is highly effective on milk protein allergy. The combined therapy can improve the immune function of infants, enhance IL-10 level, and decrease IL-22 level.

Lateral ankle avulsion fracture is a common sports injury that can lead to chronic lateral ankle instability and substantial deterioration of the joint function. Currently, problems such as misdiagnosis, inappropriate treatment, disparate outcomes and lack of standardization are usually met in the diagnosis and treatment of lateral ankle avulsion fracture. The Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians thus organized a working group of experts in the field of sports medicine and ankle surgery from China to develop "An evidence-based clinical guideline for the diagnosis and treatment of lateral ankle avulsion fractures (2022 version)" in accordance with the principle of evidence-based medicine and scientificity and practicability. The guideline covered the topics of imaging diagnosis, indications and methods of non-operative and operative treatment as well as postoperative rehabilitation, in order to provide guidance for the diagnosis and treatment of lateral ankle avulsion fracture.