BACKGROUND:Upper lumbar spinal stenosis is a multifactorial degenerative disorder of the spine.For narrowing of the spinal canal in the upper lumbar region(L1-L4),surgical decision-making is particularly complex.Existing minimally invasive surgeries each have their own advantages and limitations.Currently,there are few reports on biomechanical comparison and finite element analysis of different surgical methods for the treatment of high lumbar spinal stenosis.OBJECTIVE:To analyze the biomechanical impact of endoscopic unilateral laminotomy for bilateral decompression,transforaminal endoscopic lumbar decompression,and cross-overtop decompression in the treatment of upper lumbar spinal stenosis using endoscopy,and to verify the reliability and effectiveness of these three surgical techniques in treating upper lumbar spinal stenosis,providing a biomechanical basis for clinical decision-making.METHODS:The CT images of the lumbar spine of a healthy volunteer were selected,and the finite element model M0 of the normal lumbar L1-L5 segments was established using Mimics,Geomagic,Solid works,and Ansys software.The L2-L3 segment,representing upper lumbar characteristics,was chosen.Based on this model,the surgical models for endoscopic unilateral laminotomy for bilateral decompression(M1),transforaminal endoscopic lumbar decompression(M2),and cross-overtop decompression(M3)were established.Using software,the changes in the range of motion of the entire lumbar segment and the maximum Von Mises stress of the intervertebral discs were simulated and evaluated for each group of models under six loading conditions:flexion,extension,left lateral bending,right lateral bending,left rotation,and right rotation.RESULTS AND CONCLUSION:(1)Compared with model MO,the range of motion in M1,M2,and M3 increased under all six conditions,with M1 showing a greater increase.(2)M1 and M2 demonstrated significant increases in range of motion under forward bending,extension,and right rotation,while the increase under other conditions remained below 7％.(3)Compared with model M3,model M1 exhibited slightly increased overall joint range of motion during extension and left bending,while no significant changes were observed in other aspects,and the L1-L5 lumbar segments did not reach an unstable state.(4)In model M1,the maximum Von Mises stress of the intervertebral discs increased most significantly under flexion and extension loading conditions.However,under left lateral bending,right lateral bending,left rotation,and right rotation loading conditions,the increase did not exceed 5％.(5)These findings suggest that due to the sagittal anatomical characteristics of the facet joints,the unilateral laminotomy for bilateral decompression technique,while decompressing,involves resection of more facet joints,which impacts overall segmental stability.The transforaminal endoscopic lumbar decompression technique is suitable for patients with foraminal stenosis but cannot achieve complete decompression for those with severe ventral central stenosis.The Cross-Overtop technique effectively enlarges the volume of the central canal and lateral recess,optimizing decompression,and shows unique advantages in treating upper lumbar spinal stenosis.

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.

[摘 要] 目的：探讨Ⅱ型固有淋巴细胞（ILC2）-双调蛋白（AREG）-调节性T（Treg）细胞轴在宫颈癌免疫微环境调控中的作用及机制。方法：收集2021年5月—2022年5月于新疆医科大学第一附属医院收治的Ⅰ~ⅡA期宫颈癌患者肿瘤组织（n = 8），以子宫肌瘤手术患者的正常宫颈组织（n = 8）作为对照；另收集全分期宫颈癌患者的外周血样本（n = 30），并以健康志愿者外周血作为对照（n = 30）。利用GEPIA数据库分析AREG与叉头框蛋白P3（Foxp3）的mRNA表达水平。采用多重免疫荧光技术、流式细胞术检测组织及外周血中ILC2、Treg细胞浸润水平；通过ELISA、IHC和WB法验证AREG、Foxp3及IL-10的表达水平，并对ILC2、AREG、Treg细胞及IL-10进行相关性分析。体外分离宫颈癌患者ILC2与PBMC，分别使用重组人IL-33（rhIL-33）、抗人IL-33抗体（α-IL-33）及重组人AREG（rhAREG）、抗人AREG抗体（α-AREG）进行干预；采用CCK-8法与流式细胞术检测不同浓度rhAREG对HeLa、SiHa细胞增殖及凋亡的影响，ELISA检测上清中AREG、IL-10浓度，流式细胞术检测Treg细胞比例变化。此外，本研究还比较了宫颈癌患者手术前后外周血中ILC2、AREG、Treg细胞及IL-10的水平差异。结果：宫颈癌患者组织及外周血中ILC2浸润水平和AREG表达显著高于对照组，Treg细胞比例、Foxp3及IL-10表达亦明显上调（P < 0.05）；相关性分析显示，ILC2、Treg细胞、AREG与IL-10彼此正向关联。体外实验表明，不同浓度rhAREG对宫颈癌细胞（HeLa、SiHa）的增殖及凋亡无明显作用（P > 0.05）；rhIL-33可激活ILC2并上调AREG分泌（P < 0.01），而α-IL-33可逆转该效应（P < 0.05）；rhAREG可促进Treg细胞分化及IL-10分泌（P < 0.001），α-AREG则显著逆转上述作用（P < 0.01）。此外，宫颈癌患者术后外周血中ILC2、Treg细胞、AREG及IL-10水平均显著降低（P < 0.000 1）。结论：ILC2-AREG-Treg免疫调控轴异常激活，可能通过介导免疫抑制性肿瘤微环境形成参与宫颈癌进展。

Objective To explore the influence of the medical and health management model based on artificial intelligence (AI) on type 2 diabetes mellitus (T2DM) combined with masked hypertension (MH). Methods A total of 342 patients with T2DM admitted to the hospital from May 2021 to August 2024 were selected as research subjects, and the incidence rate of MH was counted. All patients were classified into the reference group (routine management) and the study group (AI+medical health management) according to the random number table method, with 171 cases in each group. The self-management, glycolipid metabolism and ambulatory blood pressure were compared between both groups before and after intervention. Results Among the 342 patients with T2DM, MH occurred in 34 cases, with an incidence rate of 9.94% (34/342). The self-management ability in the two groups was improved after 6 months and 12 months of intervention, and the self-management ability was higher in the study group (P<0.05). After 6 months and 12 months of intervention, the glucolipid metabolism indexes in both groups were optimized, and the improvements in the study group were greater (P<0.05). The daytime average systolic blood pressure and diastolic blood pressure, 24 h average systolic blood pressure and diastolic blood pressure were decreased in both groups after 6 months and 12 months of intervention, and the study group showed lower indexes (P<0.05). Conclusion T2DM are prone to MH. AI medical and health chronic disease management can enhance patients' self-management ability, help improve glucose and lipid metabolism, lower blood pressure, and help reduce the risk of MH.

ObjectiveThis study aimed to investigate the anti-Mycoplasma pneumoniae (MP) activity of luteolin and elucidate its underlying mechanisms. MethodsLuteolin was identified as the primary active compound from the polyphenol extract ofF. diotrys using network pharmacology. Its efficacy was evaluated against two MP strains: the standard strain M129 and the multidrug-resistant strain M19. A modified culture medium with visual characteristics was employed to determine the minimum inhibitory concentration (MIC) of luteolin. The expression of key proteins involved in MP growth and pathogenicity was assessed by qRT-PCR following luteolin treatment. Additionally, the viability of A549 cells infected with MP was compared between luteolin-treated and untreated groups. In vivo anti-MP activity was evaluated using a mouse model, and the expression of inflammatory cytokines in lung tissues was analyzed. ResultsLuteolin effectively inhibited both MP strains, with MIC₉₀ values of 100 mg/L for M19 and M129. Treatment with luteolin significantly downregulated the expression of adhesion proteins P1 and P30 in both strains. However, the expression of P65, HMW3, TrmB, and CARDS TX was reduced only in the M19 strain following luteolin intervention. Luteolin also enhanced the growth and viability of A549 cells infected with MP. In the mouse model, luteolin treatment resulted in steady weight gain and was well tolerated. The bacteriostatic rate of luteolin in lung tissues was 50.7%, significantly higher than the 25.2% observed in the roxithromycin group. Furthermore, luteolin reduced the expression of inflammatory factors, including IL-6, TNF-α, and HMGB1, in MP-infected mice. ConclusionLuteolin effectively and safely inhibits the proliferation and pathogenicity of MP, particularly the drug-resistant M19 strain, by downregulating the expression of toxicity-associated proteins (P1, P30, P65, HMW3, TrmB, CARDS TX) and modulating host inflammatory responses. These findings suggest that luteolin may offer a novel therapeutic strategy for treating MP infections, especially those caused by drug-resistant strains.

ObjectiveThis study aimed to investigate the anti-Mycoplasma pneumoniae (MP) activity of luteolin and elucidate its underlying mechanisms. MethodsLuteolin was identified as the primary active compound from the polyphenol extract ofF. diotrys using network pharmacology. Its efficacy was evaluated against two MP strains: the standard strain M129 and the multidrug-resistant strain M19. A modified culture medium with visual characteristics was employed to determine the minimum inhibitory concentration (MIC) of luteolin. The expression of key proteins involved in MP growth and pathogenicity was assessed by qRT-PCR following luteolin treatment. Additionally, the viability of A549 cells infected with MP was compared between luteolin-treated and untreated groups. In vivo anti-MP activity was evaluated using a mouse model, and the expression of inflammatory cytokines in lung tissues was analyzed. ResultsLuteolin effectively inhibited both MP strains, with MIC₉₀ values of 100 mg/L for M19 and M129. Treatment with luteolin significantly downregulated the expression of adhesion proteins P1 and P30 in both strains. However, the expression of P65, HMW3, TrmB, and CARDS TX was reduced only in the M19 strain following luteolin intervention. Luteolin also enhanced the growth and viability of A549 cells infected with MP. In the mouse model, luteolin treatment resulted in steady weight gain and was well tolerated. The bacteriostatic rate of luteolin in lung tissues was 50.7%, significantly higher than the 25.2% observed in the roxithromycin group. Furthermore, luteolin reduced the expression of inflammatory factors, including IL-6, TNF-α, and HMGB1, in MP-infected mice. ConclusionLuteolin effectively and safely inhibits the proliferation and pathogenicity of MP, particularly the drug-resistant M19 strain, by downregulating the expression of toxicity-associated proteins (P1, P30, P65, HMW3, TrmB, CARDS TX) and modulating host inflammatory responses. These findings suggest that luteolin may offer a novel therapeutic strategy for treating MP infections, especially those caused by drug-resistant strains.

Background As one of the primary operational methods in the power grid industry, the insulated glove working method imposes significant physical demands due to the constraints of insulating equipment and specific required postures, resulting in substantial occupational health hazards among workers in this sector, which have garnered widespread social attention. Objective To investigate the prevalence and influencing factors of work-related musculoskeletal disorders (WMSDs) in the neck, shoulder, and lumbar regions among workers wearing insulated gloves, and to provide targeted measures to reduce occupational hazards. Methods Using stratified cluster sampling, 1079 frontline workers were randomly selected from power supply enterprises across 3 provinces in China. The revised Chinese version of the Musculoskeletal Disorders Questionnaire was used to investigate the 1-year prevalence of WMSDs in the neck, shoulder, and lumbar regions among workers wearing insulated gloves, and to collect factors associated with multi-site WMSDs (defined as involvement of ≥2 sites among the neck, shoulder, and lumbar). Results The 1-year prevalence of WMSDs in the neck, shoulder, and lumbar regions was 39.9%, 30.0%, and 25.3%, respectively, with a multi-site WMSDs prevalence of 32.0%. Multiple logistic regression analysis showed that, compared to workers with technical secondary school education or senior high school education and below, workers with junior college education or bachelor’s degrees and above had a higher risk of multi-site WMSDs (OR=2.12, 95%CI: 1.47, 3.06). Compared to workers with <10 years of work experience, those with 10-<20 years of work experience had a higher risk of multi-site WMSDs (OR=1.96, 95%CI: 1.45, 2.67). Working in uncomfortable postures "sometimes" (OR=1.64, 95%CI: 1.14, 2.36), "frequently" (OR=2.75, 95%CI: 1.76, 4.29), and "very frequently" (OR=3.55, 95%CI: 2.04, 6.19) were significantly associated with an increased risk of multi-site WMSDs compared to never working in such postures. Frequent repetitive movements of the low back (OR=2.05, 95%CI: 1.48, 2.84) increased the risk of multi-site WMSDs, while sufficient rest time decreased the risk (OR=0.45, 95%CI: 0.34, 0.61). Conclusion The prevalences of single-site and multi-site WMSDs in the neck, shoulder, lumbar regions are relatively high among workers wearing insulated gloves. Factors associated with multi-site WMSDs include 10-<20 years of work experience, junior college education or bachelor’s degrees and above, uncomfortable working postures, frequent repetitive low-back movements, and lack of sufficient rest time.

Background As one of the primary operational methods in the power grid industry, the insulated glove working method imposes significant physical demands due to the constraints of insulating equipment and specific required postures, resulting in substantial occupational health hazards among workers in this sector, which have garnered widespread social attention. Objective To investigate the prevalence and influencing factors of work-related musculoskeletal disorders (WMSDs) in the neck, shoulder, and lumbar regions among workers wearing insulated gloves, and to provide targeted measures to reduce occupational hazards. Methods Using stratified cluster sampling, 1079 frontline workers were randomly selected from power supply enterprises across 3 provinces in China. The revised Chinese version of the Musculoskeletal Disorders Questionnaire was used to investigate the 1-year prevalence of WMSDs in the neck, shoulder, and lumbar regions among workers wearing insulated gloves, and to collect factors associated with multi-site WMSDs (defined as involvement of ≥2 sites among the neck, shoulder, and lumbar). Results The 1-year prevalence of WMSDs in the neck, shoulder, and lumbar regions was 39.9%, 30.0%, and 25.3%, respectively, with a multi-site WMSDs prevalence of 32.0%. Multiple logistic regression analysis showed that, compared to workers with technical secondary school education or senior high school education and below, workers with junior college education or bachelor’s degrees and above had a higher risk of multi-site WMSDs (OR=2.12, 95%CI: 1.47, 3.06). Compared to workers with <10 years of work experience, those with 10-<20 years of work experience had a higher risk of multi-site WMSDs (OR=1.96, 95%CI: 1.45, 2.67). Working in uncomfortable postures "sometimes" (OR=1.64, 95%CI: 1.14, 2.36), "frequently" (OR=2.75, 95%CI: 1.76, 4.29), and "very frequently" (OR=3.55, 95%CI: 2.04, 6.19) were significantly associated with an increased risk of multi-site WMSDs compared to never working in such postures. Frequent repetitive movements of the low back (OR=2.05, 95%CI: 1.48, 2.84) increased the risk of multi-site WMSDs, while sufficient rest time decreased the risk (OR=0.45, 95%CI: 0.34, 0.61). Conclusion The prevalences of single-site and multi-site WMSDs in the neck, shoulder, lumbar regions are relatively high among workers wearing insulated gloves. Factors associated with multi-site WMSDs include 10-<20 years of work experience, junior college education or bachelor’s degrees and above, uncomfortable working postures, frequent repetitive low-back movements, and lack of sufficient rest time.

Triptolide （TP）， the core active component of the traditional Chinese medicine Tripterygium wilfordii ， exhibits remarkable pharmacological activities including anti-inflammatory， immunosuppressive and anti-tumor effects， and holds broad application prospects in the treatment of major diseases such as autoimmune diseases and malignant tumors. However， TP has a narrow therapeutic window and causes multi-organ toxicities including liver， kidney and reproductive toxicities， which severely restrict its safe clinical application and new drug development. Therefore， toxicity reduction and efficacy enhancement has become a core scientific problem urgently to be solved in this field. This paper systematically reviews the four core strategies for TP toxicity reduction and efficacy enhancement， including structural modification， dosage form improvement， herbal compatibility， and external therapies of traditional Chinese medicine. Among them， structural modification optimizes the toxic and efficacy characteristics of TP from the molecular structure level， with typica l derivatives including （5 R ）-5-hydroxy triptolide， ZT01， PG490-88， etc. Dosage form modification achieves toxicity reduction and efficacy enhancement via targeted and sustained-controlled drug release of diverse delivery systems. It includes triptolide preparations such as nanoparticles， liposomes， microemulsion gels and liquid crystals， possessing favorable clinical transformation potential. The herbal compatibility and external therapies of traditional Chinese medicine conform to the holistic view of traditional Chinese medicine and have a profound clinical application foundation， but their mechanisms of action are insufficiently elucidated， and they lack unified standardized specifications and high-quality evidence-based proof. In the future， we should rely on multi-omics technology to elucidate the toxic and efficacy mechanisms， integrate technologies to optimize preparations， improve the evaluation system and promote clinical transformation.

Objective: To explore whether digital facial and tongue diagnostic technologies can support the assessment of coronary heart disease (CHD) patients for coronary artery stenosis severity, and examine potential associations between digital tongue diagnosis features and myocardial biomarkers. Methods: The TFDA-1 face and tongue diagnosis instrument and the TDAS analysis system were used to perform intelligent visual examination and analysis of the facial and tongue in CHD patients who attended the Department of Cardiology at Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine between October 2, 2023 and July 31, 2024. Variables were screened using principal component analysis (PCA) and multicollinearity analysis to construct four machine learning models, including random forest, LightGBM, decision tree, and naive Bayes, for the early prediction of coronary artery stenosis severity. Model performance metrics, including sensitivity, specificity, precision, F1 score, accuracy, and the area under the receiver operating characteristic (ROC) curve (AUC), were evaluated. Visual analyses were performed using the SHapley Additive exPlanations (SHAP) interpreter and decision curve analysis. For patients after percutaneous coronary intervention (PCI), a conceptual model linking cardiac biomarkers and tongue diagnosis was constructed using the partial least squares structural equation modeling (PLS-SEM), and its validity was assessed. Results: A total of 459 CHD patients were enrolled and assigned to a PCI group and a non-PCI group (which comprised two subgroups: mild stenosis or less group, moderate stenosis or greater group). For sublingual vein (SV) features, the PCI group had lower SV-a and SV-b than the other groups (P < 0.01 and P < 0.05, respectively). For tongue surface features, the PCI group had significantly higher tongue body (TB)-L, TB-a, and TB-b (P < 0.05, P < 0.01, and P < 0.001, respectively), as well as higher tongue coating (TC)-a and TC-b (P < 0.01 and P < 0.001, respectively). Age, SV-a, SV-b, creatine kinase-myocardial band (CK-MB), CK, TC-a, lip-L, and lip-b were incorporated in the machine learning models. The random forest model performed best, with an AUC of 0.924, an F1 score of 0.839, precision of 0.807, accuracy of 0.864, sensitivity of 0.873, and specificity of 0.839. Decision curve analysis indicated that both LightGBM and random forest had clinical utility. PLS-SEM confirmed the pathway relationships: myocardial biomarkers → TB and myocardial biomarkers → TC (coefficient = – 0.238, t = 2.239, P = 0.025, and coefficient = – 0.270, t = 2.522, P = 0.012, respectively). Conclusion This study developed a noninvasive early warning model for coronary artery stenosis in patients with CHD. It applied PLS-SEM to investigate the association between post-PCI cardiac biomarkers and tongue diagnosis, and validated the proposed association chain. These findings suggest that intelligent traditional Chinese medicine (TCM) visual diagnosis integrated with modern digital technology may support CHD risk assessment and comprehensive health management.