Objective Based on the finite element simulation analysis of the patient's torso-spine model and combined with theoretical calculation data,an individualized scoliosis orthosis was designed,and the effectiveness of the orthosis was verified through three-dimensional(3D)printing.Methods A patient with idiopathic scoliosis was chosen as the research object.Reverse engineering technology and computer-aided technology were used to establish the torso-spine model of the patient.The finite element method was used to analyze the model,and the optimal position and magnitude of the corrective force were determined by combining literature theory calculation.Based on this,an orthosis was designed.To verify the orthopedic effect,the patient's X-rays before and after wearing the orthosis were compared and evaluated,and the patient was followed up 6 months later.Results The optimal position and magnitude of the initial corrective force were determined through theoretical calculations and finite element simulations.Specifically,a 62.95 N corrective force applied to the L3 vertebral body and the left posterior region corresponding to the upper and lower intervertebral discs in the patient's lateral curvature segment of the spine to achieve the optimal orthopedic effect.On this basis,the orthosis was designed,followed by relevant experimental tests before and after wearing the designed orthosis.By comparing X-ray images of the patient before and after wearing the orthosis and combining them with follow-up data six months later,the optimized design of the orthosis met the expected clinical requirements for orthopedic effects.Conclusions The design of orthosis needs to be personalized according to the specific situation of patients with scoliosis.This study takes a patient with idiopathic scoliosis as the research object,providing new ideas and methods for the design of orthosis for patients with idiopathic scoliosis.

Subunit 5B of constitutively photomorphogenic 9 signalosome(CSN5B)is an inhibitory factor for the biosynthesis of vitamin C in the L-galactose synthesis pathway in plants.To create mutants with richer vitamin C in tomato fruits,a dual-target vector of pKSE402-SlCSN5Bwas constructed and trans-formed into the breeding parent of 1912.Based on the molecular biological assay and DNA sequencing,17 transgenic positive lines were determined,and 6 lines of them were genetically mutated at the target site of SlCSN5B,with an editing efficiency of 35.3％.Among the mutants,2 lines were homozygous mu-tants,csn5b-6 with 180 bp deletion and csn5b-8 with 3 bp deletion.The biological traits of two types of deficiency homozygotes without exogenous T-DNA insertion derived from the T1 generation were observed,and there were no significant differences in phenotypes of the plant and fruit.Through physiological tes-ting of red-ripe fruits from T,generation lines of csn5b-6,the GMPase activity and the vitamin C content significantly increased by 43％and 37.8％,respectively,the content of hydrogen peroxide significantly decreased by 25.9％,and the content of soluble solids did not obviously change,compared with the wild type.There were no significant differences in plant traits and physiological characteristics between T1 gen-eration lines of csn5b-8 and the wild type.Based on gene expression analysis and protein structure predic-tion,the results showed that the gene of SlCSN5B normally transcribed,and the loss of large peptide seg-ments of CSN5B encoded by SlCSN5B caused changes in its structure to affect functioning,which led to an increase of vitamin C content in the line of csn5b-6-1 1.The findings suggest that the vitamin C content of tomato fruit can be improved by CRISPR/Cas9-mediated SlCSN5B gene editing,which provides the valuable resources for high-quality breeding in tomato.

Genetics,which provides important theoretical knowledge for the cultivation of students majo-ring in biology,is a discipline that studies the law of biological heredity and variation.In the era of high-ly advanced information technology,the blended online and offline teaching model has progressively been integrated into university classrooms,which seamlessly merges offline teaching with"Internet+"and greatly improves the outcomes and effectiveness of student learning and teacher instruction.Taking the genetics course as a platform,this paper first examines the complementary features of online and offline teaching methods.Then,the genetic teaching model that was carried out through various online platforms and resources were designed and optimized from purely online instruction and blended online-offline in-struction respectively.The assessment and evaluation methodologies were also enhanced.The findings of the investigation on the impact of teaching practices showed that a notable enhancement in students'en-thusiasm for learning genetic courses was achieved.This was reflected in the fact that an increasing num-ber of students selected genetic-related topics in science and innovation competitions.Meanwhile,com-pared with the non-implementation of blended teaching reform,students'academic performance in genet-ics courses has also been significantly improved,with a total score of about 5-6 points.The implementa-tion of the innovative blended teaching model will further enhance the efficiency of classroom teaching in-novation and talent training.

This study aims to explore the synergistic effects of the main components in salvianolic acids for Injection(SAFI) on key pathological events in cerebral ischemia, elucidating the pharmacological characteristics of SAFI in neuroprotection. Two major pathological gene modules related to endothelial injury and neuroinflammation in cerebral ischemia were mined from single-cell data. According to the topological distance calculated in network medicine, potential synergistic component combinations of SAFI were screened out. The results showed that the combination of caffeic acid and salvianolic acid B scored the highest in addressing both endothelial injury and neuroinflammation, demonstrating potential synergistic effects. The cell experiments confirmed that the combination of these two components at a ratio of 1∶1 significantly protected brain microvascular endothelial cells(bEnd.3) from oxygen-glucose deprivation/reoxygenation(OGD/R)-induced reperfusion injury and effectively suppressed lipopolysaccharide(LPS)-induced neuroinflammatory responses in microglial cells(BV-2). This study provides a new method for uncovering synergistic effects among active components in traditional Chinese medicine(TCM) and offers novel insights into the multi-component, multi-target acting mechanisms of TCM.
Brain Ischemia/metabolism* ; Neuroprotective Agents/pharmacology* ; Animals ; Drugs, Chinese Herbal/administration & dosage* ; Benzofurans/pharmacology* ; Mice ; Drug Synergism ; Caffeic Acids/pharmacology* ; Polyphenols/pharmacology* ; Humans ; Alkenes/pharmacology* ; Endothelial Cells/drug effects* ; Depsides

INTRODUCTION: Obstructive sleep apnoea (OSA) is common in Singapore, with moderate to severe OSA affecting around 30% of residents. These consensus statements aim to provide scientifically grounded recommendations for the management of OSA, standar-dise the management of OSA in Singapore and promote multidisciplinary collaboration. METHOD: An expert panel, which was convened in 2024, identified several areas of OSA management that require guidance. The expert panel reviewed the current literature and developed consensus statements, which were later independently voted on using a 3-point Likert scale (agree, neutral or disagree). Consensus (total ratings of agree and neutral) was set a priori at ≥80% agreement. Any statement not reaching consensus was excluded. RESULTS: The final consensus included 49 statements that provide guidance on the screening, diagnosis and management of adults with OSA. Additionally, 23 statements on the screening, diagnosis and management of paediatric OSA achieved consensus. These 72 consensus statements considered not only the latest clinical evidence but also the benefits and harms, resource implications, feasibility, acceptability and equity impact of the recommendations. CONCLUSION The statements presented in this paper aim to guide clinicians based on the most updated evidence and collective expert opinion from sleep specialists in Singapore. These recommendations should augment clinical judgement rather than replace it. Management decisions should be individualised, taking into account the patient's clinical characteristics, as well as patient and caregiver concerns and preferences.
Humans ; Sleep Apnea, Obstructive/diagnosis* ; Singapore ; Consensus ; Adult

Subunit 5B of constitutively photomorphogenic 9 signalosome(CSN5B)is an inhibitory factor for the biosynthesis of vitamin C in the L-galactose synthesis pathway in plants.To create mutants with richer vitamin C in tomato fruits,a dual-target vector of pKSE402-SlCSN5Bwas constructed and trans-formed into the breeding parent of 1912.Based on the molecular biological assay and DNA sequencing,17 transgenic positive lines were determined,and 6 lines of them were genetically mutated at the target site of SlCSN5B,with an editing efficiency of 35.3％.Among the mutants,2 lines were homozygous mu-tants,csn5b-6 with 180 bp deletion and csn5b-8 with 3 bp deletion.The biological traits of two types of deficiency homozygotes without exogenous T-DNA insertion derived from the T1 generation were observed,and there were no significant differences in phenotypes of the plant and fruit.Through physiological tes-ting of red-ripe fruits from T,generation lines of csn5b-6,the GMPase activity and the vitamin C content significantly increased by 43％and 37.8％,respectively,the content of hydrogen peroxide significantly decreased by 25.9％,and the content of soluble solids did not obviously change,compared with the wild type.There were no significant differences in plant traits and physiological characteristics between T1 gen-eration lines of csn5b-8 and the wild type.Based on gene expression analysis and protein structure predic-tion,the results showed that the gene of SlCSN5B normally transcribed,and the loss of large peptide seg-ments of CSN5B encoded by SlCSN5B caused changes in its structure to affect functioning,which led to an increase of vitamin C content in the line of csn5b-6-1 1.The findings suggest that the vitamin C content of tomato fruit can be improved by CRISPR/Cas9-mediated SlCSN5B gene editing,which provides the valuable resources for high-quality breeding in tomato.

OBJECTIVE: As an age-related neurodegenerative disease, the prevalence of mild cognitive impairment (MCI) increases with age. Within the framework of traditional Chinese medicine, spleen-kidney deficiency syndrome (SKDS) is recognized as the most frequent MCI subtype. Due to the covert and gradual onset of MCI, in community settings it poses a significant challenge for patients and their families to discern between typical aging and pathological changes. There exists an urgent need to devise a preliminary diagnostic tool designed for community-residing older adults with MCI attributed to SKDS (MCI-SKDS). METHODS: This investigation enrolled 312 elderly individuals diagnosed with MCI, who were randomly distributed into training and test datasets at a 3:1 ratio. Five machine learning methods, including logistic regression (LR), decision tree (DT), naive Bayes (NB), support vector machine (SVM), and gradient boosting (GB), were used to build a diagnostic prediction model for MCI-SKDS. Accuracy, sensitivity, specificity, precision, F1 score, and area under the curve were used to evaluate model performance. Furthermore, the clinical applicability of the model was evaluated through decision curve analysis (DCA). RESULTS: The accuracy, precision, specificity and F1 score of the DT model performed best in the training set (test set), with scores of 0.904 (0.845), 0.875 (0.795), 0.973 (0.875) and 0.973 (0.875). The sensitivity of the training set (test set) of the SVM model performed best among the five models with a score of 0.865 (0.821). The area under the curve of all five models was greater than 0.9 for the training dataset and greater than 0.8 for the test dataset. The DCA of all models showed good clinical application value. The study identified ten indicators that were significant predictors of MCI-SKDS. CONCLUSION The risk prediction index derived from machine learning for the MCI-SKDS prediction model is simple and practical; the model demonstrates good predictive value and clinical applicability, and the DT model had the best performance. Please cite this article as: Ai YT, Zhou S, Wang M, Zheng TY, Hu H, Wang YC, Li YC, Wang XT, Zhou PJ. Development of a machine learning-based risk prediction model for mild cognitive impairment with spleen-kidney deficiency syndrome in the elderly. J Integr Med. 2025; 23(4): 390-397.
Humans ; Cognitive Dysfunction/diagnosis* ; Aged ; Male ; Female ; Machine Learning ; Spleen ; Aged, 80 and over ; Kidney ; Medicine, Chinese Traditional

Objective:To investigate the effects of surgical timing on incidence of perioperative complications and postoperative 30-day mortality in elderly patients with hip fracture.Methods:The data were retrospectively analyzed of the 450 elderly patients with hip fracture who had been admitted to Department of Joint Surgery, Beijing Shijitan Hospital, Capital Medical University from January 2016 to December 2021. The patients were divided into 2 groups according to the time from admission to surgery. In the early surgery group of 143 cases [41 males and 102 females with an age of 82(75, 86) years], the time from admission to surgery was ≤ 48 hours. In the delayed surgery group of 307 cases [88 males and 219 females with an age of 83(77, 87) years], the time from admission to surgery was over 48 hours. The 2 groups were compared in terms of comorbidities, perioperative complications, death events within postoperative 30 days, ICU transfer rate and total length of hospital stay.Results:There was no significant difference in the preoperative general data like age and gender between the 2 groups, indicating comparability ( P>0.05). The proportions of patients with coronary atherosclerotic heart disease [30.0%(92/307)], a stroke history [19.9%(61/307)], abnormal heart function [55.4%(170/307)] and abnormal kidney function [24.4%(75/307)] in the delayed surgery group were significantly higher than those in the early surgery group [18.2%(26/143), 10.5% (15/143), 39.2%(56/143), and 12.6%(18/143)] ( P<0.05). The proportions of perioperative pulmonary infection [22.5% (69/307)] and urinary infection [21.2%(65/307)] in the delayed operation group were significantly higher than those in the early operation group [11.9%(17/143) and 11.2%(16/143)] ( P<0.05). The total hospital stay in the delayed operation group [18(14, 22) d] was significantly longer than that in the early operation group [14(10, 17) d] ( P<0.05). There was no significant difference in ICU transfer rate or postoperative 30-day mortality between the 2 groups ( P>0.05). Conclusion:For elderly patients with hip fracture, delayed surgery may increase the incidence of pulmonary infection and urinary infection, and extend their total hospital stay, but have no effect on the postoperative 30-day mortality.

Genetics,which provides important theoretical knowledge for the cultivation of students majo-ring in biology,is a discipline that studies the law of biological heredity and variation.In the era of high-ly advanced information technology,the blended online and offline teaching model has progressively been integrated into university classrooms,which seamlessly merges offline teaching with"Internet+"and greatly improves the outcomes and effectiveness of student learning and teacher instruction.Taking the genetics course as a platform,this paper first examines the complementary features of online and offline teaching methods.Then,the genetic teaching model that was carried out through various online platforms and resources were designed and optimized from purely online instruction and blended online-offline in-struction respectively.The assessment and evaluation methodologies were also enhanced.The findings of the investigation on the impact of teaching practices showed that a notable enhancement in students'en-thusiasm for learning genetic courses was achieved.This was reflected in the fact that an increasing num-ber of students selected genetic-related topics in science and innovation competitions.Meanwhile,com-pared with the non-implementation of blended teaching reform,students'academic performance in genet-ics courses has also been significantly improved,with a total score of about 5-6 points.The implementa-tion of the innovative blended teaching model will further enhance the efficiency of classroom teaching in-novation and talent training.

OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies