OBJECTIVE: To establish foot and ankle models of different lateral collateral ligament injuries of ankle joint, and conduct finite element analysis on, and to explore the force conditions of subtalar articular cartilage during foot inversion movements under different gait stages and under different loads. METHODS: A normal ankle CT scan of a 30-year-old male healthy volunteer (heighted 175 cm and weighted 60 kg) was selected. The CT images were imported into software such as Mimics 21.0, Geomajic 2017, and Solidworks 2017 respectively, extract the normal ankle bone model. Then, the foot and ankle finite element models of different lateral collateral ligament injuries of ankle joint were constructed and divided into anterior talofibular ligament(ATFL) rupture group, ATFL and calcaneo fibular ligament (CFL) rupture group, ATFL, CFL and posterior talofibular ligament (PTFL) rupture group, and control group with intact ligament function by ANSYS 2021. Corresponding horizontal and vertical loads and torques were applied respectively on tibia and talus according to the force conditions of different phases to simulate landing phase, neutral and off-ground phase in walking gait. The changes in stress distribution area and stress peak of subtalar articular cartilage in the loading phase, neutral phase and off-ground phase gaits among four groups were observed. Simulate varus sprain action, apply different loads of 600, 1, 800, and 4, 200 N respectively, and changes in stress distribution area and the stress peak of subtalar articular cartilage among four groups of models were observed. RESULTS: In the gait simulation, the stress results of loading phase in ATFL fracture group, ATFL and CFL fracture groups, ATFL, CFL and PTFL fracture groups, and control group were 0.889 54, 0.960 89, 1.139 20, and 0.722 64 MPa, respectively. The neutral response force results were 1.250 60, 1.358 50, 1.363 70, 1.246 40 MPa respectively;the results of corresponding forces off-ground phase were 1.029 90, 1.138 70, 1.145 90 and 0.832 40 MPa respectively. In the inversion simulation, the stresses of ATFL fracture group, ATFL and CFL fracture groups, ATFL, CFL and PTFL fracture groups, and control group under load of 600 N were 2.191 3, 2.208 5, 2.215 7, and 2.156 6 MPa respectively. The stresses under a load of 1 800 N were 7.134 7, 9.715 2, 10.064 0, and 7.107 0 MPa respectively;the stresses under a load of 4 200 N were 17.435 0, 25.309 0, 26.119 0 and 16.010 0 MPa respectively. CONCLUSION The lateral collateral ligament of ankle joint plays an important role in the stability of the subtalar joint, especially CFL plays an important role in restricting calcaneal varus. If these ligaments are damaged, it will cause instability of the subtalar joint and further lead to lesions in the subtalar articular cartilage. Relevant exercises should be reduced or the ligament injuries should be treated in a timely manner.
Humans ; Finite Element Analysis ; Male ; Adult ; Cartilage, Articular/physiopathology* ; Ankle Injuries/physiopathology* ; Ankle Joint/physiopathology* ; Biomechanical Phenomena ; Subtalar Joint/injuries* ; Tomography, X-Ray Computed

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To investigate the value of CT radiomics for predicting effect of neoadjuvant chemotherapy(NACT)for locally advanced gastric cancer(LAGC).Methods Totally 325 LAGC patients who received NACT were retrospectively enrolled,among them 247 were taken as training set,while the rest 78 were taken as validation set.Tumor regression scale(TRG)was evaluated according to postoperation pathology after NACT,and the efficacy of NACT was evaluated.Univariate logistic regression was used to analyze and screen clinical predictors of effect of NACT,and clinical model was constructed.Radiomics features were extracted based on venous phase enhanced CT pre-and post-NACT,and Delta radiomics features(i.e.the ratio of the difference of pre-and post-NACT radiomics features and pre-NACT radiomics features)were calculated.The best features were screened based on pre-NACT,post-NACT and Delta radiomics features to construct radiomics labels,the optimal label was screened and used to construct combined model through combining clinical model.Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate predicting efficiency of the above models.Decision curve analysis(DCA)was performed to explore the clinical value of each model.Results In training set,significant effect was found in 67 cases,but not in 180 cases,while in validation set,significant effect was found in 18 cases but not in 60 cases.Borrmann classification of LAGC before NACT was the clinical predictor(P=0.031),and clinical model was constructed,which had AUC of 0.577 and 0.520 in training and validation sets,respectively.Based on pre-NACT,post-NACT and Delta radiomics features,19,14 and 17 best features were selected,and AUC of the established radiomics labels of Pre-Rad,Post-Rad and Delta-Rad in training set was 0.672,0.796 and 0.789,while in validation set was 0.558,0.805 and 0.666,respectively.Post-Rad was the optimal label,which was used to construct combined model.AUC of the obtained combined model in training and validation sets was 0.824 and 0.818,respectively,both higher than that of clinical model(both P＜0.001)but not different with that of Post-Rad(both P＞0.05).Taken 0.4 to 0.7 as the threshold,the combined model had higher clinical net benefit than the other two.Conclusion Venous CT radiomics could effectively predict effect of NACT for LAGC.Combining with clinical features could improve its predictive efficacy.

BACKGROUND:Rheumatoid arthritis is a complex autoimmune disease characterized by joint swelling,pain,and progressive damage.The basic pathological changes include synovitis and pannus formation,with T lymphocyte infiltration being the key to its pathogenesis.In recent years,the application of traditional Chinese medicine(TCM)monomers in the treatment of rheumatoid arthritis has attracted increasing attention.They have shown long-lasting effcacy and fewer side effects by regulating the T helper cell 17(Th17)/regulatory T cells(Treg)balance in the treatment of rheumatoid arthritis.OBJECTIVE:To discuss the mechanisms by which TCM monomers regulate the Th17/Treg balance to treat rheumatoid arthritis,based on the latest basic research,providing a solid theoretical basis for future applications of TCM in the treatment of rheumatoid arthritis.METHODS:Using keywords such as"rheumatoid arthritis,Th17/Treg,traditional Chinese medicine,Chinese herbal monomer,"and their Chinese equivalents,literature searches were conducted in PubMed,Web of Science,Embase,Cochrane,VIP,CBM,CNKI,and WanFang databases for relevant studies from their inception to August 2024.Inclusion and exclusion criteria were established,and the articles were screened by reading the titles,abstracts,and full texts.Finally,57 relevant articles were included.RESULTS AND CONCLUSION:(1)TCM monomers have immunoregulatory effects in the treatment of rheumatoid arthritis.They exert therapeutic effects by maintaining the Th17/Treg balance through the regulation of transcription factors,cytokines,signaling pathways,and miRNAs.(2)There may be synergistic effects among some TCM monomers,but the specific mechanisms and enhancement effects in regulating the Th17/Treg balance require further exploration.(3)Regulating the Th17/Treg balance using TCM monomers may become a key clinical therapy for the treatment of rheumatoid arthritis.

Objective To investigate the value of CT radiomics for predicting effect of neoadjuvant chemotherapy(NACT)for locally advanced gastric cancer(LAGC).Methods Totally 325 LAGC patients who received NACT were retrospectively enrolled,among them 247 were taken as training set,while the rest 78 were taken as validation set.Tumor regression scale(TRG)was evaluated according to postoperation pathology after NACT,and the efficacy of NACT was evaluated.Univariate logistic regression was used to analyze and screen clinical predictors of effect of NACT,and clinical model was constructed.Radiomics features were extracted based on venous phase enhanced CT pre-and post-NACT,and Delta radiomics features(i.e.the ratio of the difference of pre-and post-NACT radiomics features and pre-NACT radiomics features)were calculated.The best features were screened based on pre-NACT,post-NACT and Delta radiomics features to construct radiomics labels,the optimal label was screened and used to construct combined model through combining clinical model.Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate predicting efficiency of the above models.Decision curve analysis(DCA)was performed to explore the clinical value of each model.Results In training set,significant effect was found in 67 cases,but not in 180 cases,while in validation set,significant effect was found in 18 cases but not in 60 cases.Borrmann classification of LAGC before NACT was the clinical predictor(P=0.031),and clinical model was constructed,which had AUC of 0.577 and 0.520 in training and validation sets,respectively.Based on pre-NACT,post-NACT and Delta radiomics features,19,14 and 17 best features were selected,and AUC of the established radiomics labels of Pre-Rad,Post-Rad and Delta-Rad in training set was 0.672,0.796 and 0.789,while in validation set was 0.558,0.805 and 0.666,respectively.Post-Rad was the optimal label,which was used to construct combined model.AUC of the obtained combined model in training and validation sets was 0.824 and 0.818,respectively,both higher than that of clinical model(both P＜0.001)but not different with that of Post-Rad(both P＞0.05).Taken 0.4 to 0.7 as the threshold,the combined model had higher clinical net benefit than the other two.Conclusion Venous CT radiomics could effectively predict effect of NACT for LAGC.Combining with clinical features could improve its predictive efficacy.

BACKGROUND:Rheumatoid arthritis is a complex autoimmune disease characterized by joint swelling,pain,and progressive damage.The basic pathological changes include synovitis and pannus formation,with T lymphocyte infiltration being the key to its pathogenesis.In recent years,the application of traditional Chinese medicine(TCM)monomers in the treatment of rheumatoid arthritis has attracted increasing attention.They have shown long-lasting effcacy and fewer side effects by regulating the T helper cell 17(Th17)/regulatory T cells(Treg)balance in the treatment of rheumatoid arthritis.OBJECTIVE:To discuss the mechanisms by which TCM monomers regulate the Th17/Treg balance to treat rheumatoid arthritis,based on the latest basic research,providing a solid theoretical basis for future applications of TCM in the treatment of rheumatoid arthritis.METHODS:Using keywords such as"rheumatoid arthritis,Th17/Treg,traditional Chinese medicine,Chinese herbal monomer,"and their Chinese equivalents,literature searches were conducted in PubMed,Web of Science,Embase,Cochrane,VIP,CBM,CNKI,and WanFang databases for relevant studies from their inception to August 2024.Inclusion and exclusion criteria were established,and the articles were screened by reading the titles,abstracts,and full texts.Finally,57 relevant articles were included.RESULTS AND CONCLUSION:(1)TCM monomers have immunoregulatory effects in the treatment of rheumatoid arthritis.They exert therapeutic effects by maintaining the Th17/Treg balance through the regulation of transcription factors,cytokines,signaling pathways,and miRNAs.(2)There may be synergistic effects among some TCM monomers,but the specific mechanisms and enhancement effects in regulating the Th17/Treg balance require further exploration.(3)Regulating the Th17/Treg balance using TCM monomers may become a key clinical therapy for the treatment of rheumatoid arthritis.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To evaluate the efficacy and safety of denosumab in the treatment of prostate cancer with bone metastases.Methods:Relevant studies were retrieved from PubMed,EMBASE,Cochrane,Web of Science,Sinomed,CNKI and Wanfang data-bases.The Cochrane risk-of-bias assessment tool was used to evaluate the quality of included studies,and relevant data were extracted.meta-analysis was performed using RevMan 5.4 and RStudio software,and forest plots were generated.Results:Six randomized con-trolled trials(RCTs)were included.Compared with the control group,denosumab significantly reduced the risk of skeletal-related e-vents(HR=0.78,95％CI:0.62-0.93).In terms of safety,denosumab did not increase the risk of total adverse events,severe adverse events and the adverse events higher than CTC grade 3.Conclusion:Denosumab can delay the time to first skeletal-related event with good safety.However,due to the limitations of this study,further high-quality,large-sample,multicenter RCTs are needed to confirm these findings.

In recent years， the incidence of pulmonary nodules has kept rising. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of pulmonary nodules and identify the breakthrough points of integrating TCM with Western medicine， the China Association of Chinese Medicine organized medical experts in TCM and western medicine to carry out in-depth discussion regarding this disease. The discussion encompassed the modern medical advances， TCM theories of etiology and pathogenesis， the role and advantages of TCM in the whole course management of pulmonary nodules， contents and methods of research on pulmonary nodules， and science popularization work， aiming to provide a reference for clinical practice and scientific research. After discussion， the experts concluded that the occurrence of pulmonary nodules was rooted in the deficiency of the lung and spleen and triggered by phlegm dampness， blood stasis， and Qi stagnation. TCM can treat pulmonary nodules by controlling and reducing nodules， improving physical constitution， ameliorating multi-system nodular diseases， reducing anxiety and avoiding excessive diagnosis and treatment， and serving as an alternative for patients who are unwilling or unfit for surgical treatment. At present， the optimal diagnosis and treatment strategy for pulmonary nodules has not been formed， which needs to be further studied from multiple perspectives such as clinical epidemiology， biology， and evidence-based medicine. The primary task of current research is to find out the advantages， effective prescriptions， and target populations and determine the effective outcomes of TCM in the treatment of pulmonary nodules. At the same time， basic research should be carried out to explore the etiology and biological behaviors of pulmonary nodules. The expert consensus on the diagnosis and treatment of pulmonary nodules with integrated TCM and Western medicine needs to be continuously revised to guide clinicians to conduct standardized， scientific， and accurate effective diagnosis and treatment.

ObjectiveTo investigate the epidemiological trends of influenza in Yiwu City， Zhejiang Province from 2017 to 2022， and to provide references for local adjustments to influenza prevention and control strategies. MethodsReal-time fluorescence quantitative PCR was used to detect and type influenza viruses in nasal and pharyngeal swab specimens of the patients with influenza-like illness （ILI）. The results were statistically analyzed. ResultsFrom 2017 to 2022， a total of 106 661 ILI cases were reported in Yiwu City， with annual reported cases of 31 273， 33 522， 20 090， 9 965， 3 202， and 8 609， respectively. The majority of ILI cases were in the age group of ≤14 years， accounting for 89.16%. A total of 6 893 specimens were collected and tested， of which 945 were tested positive for influenza virus nucleic acid， with an overall positivity rate of 13.71%. The dominant subtypes were H3N2 and B⁃Victoria， accounting for 40.63% （384/945） and 35.03% （331/945） respectively. The highest positivity rate was in 2019， at 25.19% （265/1 052）. The positivity rates significantly decreased in 2020 and 2021， to 5.74% （66/1 149） and 5.77% （75/1 300）， respectively. The rate increased in 2022 to 13.85% （180/1 300）. The highest proportion of A/H3N2 positivity was in 2017， at 69.14% （168/243）. The highest proportion of A/H1N1 positivity was in 2018，at 50.86%（59/116）. The highest proportion of B/Victoria positivity was in 2021， at 100.00% （75/75）. The highest proportion of B/Yamagata positivity was in 2018， at 5.17% （6/116）. ConclusionInfluenza in Yiwu City exhibits obvious seasonal patterns， with two peaks in winter-spring and summer. Dominant strains such as A/H3N2， B/Victoria， and A/H1N1 alternate or co-circulate. During the COVID-19 pandemic， seasonal influenza significantly decreased， and a series of prevention and control measures had a positive effect on influenza prevention and control.