BACKGROUND:The plantarflexor weakness is a common muscle defect in patients with spastic cerebral palsy and Charcot-Marie-Tooth,which clinically manifests abnormal gaits,and the relationship between plantarflexor weakness and abnormal gaits is unclear. OBJECTIVE:To explore the biomechanical behavior of the lower limb under the action of a single factor of plantarflexor weakness to reveal the mechanism of abnormal gait induced by plantarflexor weakness and to provide guidance for the rehabilitation training of patients with plantarflexor weakness. METHODS:A predictive framework of musculoskeletal multibody dynamics in the sagittal plane was established based on OpenSim Moco to predict lower limb joint angles and muscle activation changes during walking in normal subjects.The validity of the framework was verified by combining the inverse kinematics and electromyogram activation time of the experimental data.Reduced isometric muscle forces were used to model plantarflexor weakness and to compare predicted lower extremity joint angles,joint moments,and muscle energy expenditure with normal subjects to analyze the effects of plantarflexor weakness on lower extremity biomechanics. RESULTS AND CONCLUSION:(1)The Moco-based prediction framework realistically predicted the biomechanical changes of the lower limbs during walking in normal subjects(joint angles:normalized correlation coefficient≥0.73,root mean square error≤7.10°).(2)The musculoskeletal model used a small stride support phase to increase the"heel-walking"gait during plantarflexor weakness.When the plantarflexor weakness reached 80%,the muscle energy expenditure was 5.691 4 J/kg/m,and the maximum activation levels of the gastrocnemius and soleus muscles were 0.72 and 0.53,which might cause the plantarflexor weakness patients to be more prone to fatigue when walking.(3)Muscle energy expenditure was significantly higher when the weakness of plantarflexors exceeded 40%,and the joint angles and moments of the lower limbs deteriorated significantly when the weakness of plantarflexors exceeded 60%,suggesting that there may be a"threshold"for the effect of plantarflexor weakness on gait,which may correspond to the point at which health care professionals should intervene in the clinical setting.

Methods: Patients with Lenke 1 AIS undergoing posterior spinal fusion were included. Standing and fulcrum bending radiographs on the coronal and sagittal planes were analyzed at preoperative, immediate, and 2-year postoperative periods. The primary outcome was postoperative hypokyphosis (T5–12 thoracic kyphosis [TK] <20°). Risk factors for postoperative hypokyphosis were identified by multivariate logistic regression, and the optimal cutoff for significant risk factors was determined by receiver operating characteristic analysis. Results: In total, 156 patients were included in the analysis, of which 68 (43.6%) were hypokyphotic at 2-year follow-up. Low T5–12 TK on lateral view fulcrum bending films (immediate postoperative odds ratio [OR], 0.870; 95% confidence interval [CI], 0.826–0.917; 2-year postoperative OR, 0.916; 95% CI, 0.876–0.959; p<0.001) and high convex side implant density (2-year postoperative OR, 1.749; 95% CI, 1.056–2.897; p=0.03) were significant risk factors for postoperative hypokyphosis. Other baseline demographic and surgical factors did not affect postoperative kyphosis correction. The T5–12 TK cutoff on fulcrum bending for 2-year postoperative hypokyphosis was 12.45° (area under the curve, 0.773; 95% CI, 0.661–0.820). Conclusions Fulcrum bending radiography is useful in assessing coronal and sagittal flexibility for preoperative planning. In patients with T5–12 kyphosis <12.5° on lateral view fulcrum bending radiographs, Ponte osteotomies or releases, or a decrease in convex side implant density should be considered to improve kyphosis restoration and reduce the risk of 2-year postoperative hypokyphosis.

Methods: Patients with Lenke 1 AIS undergoing posterior spinal fusion were included. Standing and fulcrum bending radiographs on the coronal and sagittal planes were analyzed at preoperative, immediate, and 2-year postoperative periods. The primary outcome was postoperative hypokyphosis (T5–12 thoracic kyphosis [TK] <20°). Risk factors for postoperative hypokyphosis were identified by multivariate logistic regression, and the optimal cutoff for significant risk factors was determined by receiver operating characteristic analysis. Results: In total, 156 patients were included in the analysis, of which 68 (43.6%) were hypokyphotic at 2-year follow-up. Low T5–12 TK on lateral view fulcrum bending films (immediate postoperative odds ratio [OR], 0.870; 95% confidence interval [CI], 0.826–0.917; 2-year postoperative OR, 0.916; 95% CI, 0.876–0.959; p<0.001) and high convex side implant density (2-year postoperative OR, 1.749; 95% CI, 1.056–2.897; p=0.03) were significant risk factors for postoperative hypokyphosis. Other baseline demographic and surgical factors did not affect postoperative kyphosis correction. The T5–12 TK cutoff on fulcrum bending for 2-year postoperative hypokyphosis was 12.45° (area under the curve, 0.773; 95% CI, 0.661–0.820). Conclusions Fulcrum bending radiography is useful in assessing coronal and sagittal flexibility for preoperative planning. In patients with T5–12 kyphosis <12.5° on lateral view fulcrum bending radiographs, Ponte osteotomies or releases, or a decrease in convex side implant density should be considered to improve kyphosis restoration and reduce the risk of 2-year postoperative hypokyphosis.

Methods: Patients with Lenke 1 AIS undergoing posterior spinal fusion were included. Standing and fulcrum bending radiographs on the coronal and sagittal planes were analyzed at preoperative, immediate, and 2-year postoperative periods. The primary outcome was postoperative hypokyphosis (T5–12 thoracic kyphosis [TK] <20°). Risk factors for postoperative hypokyphosis were identified by multivariate logistic regression, and the optimal cutoff for significant risk factors was determined by receiver operating characteristic analysis. Results: In total, 156 patients were included in the analysis, of which 68 (43.6%) were hypokyphotic at 2-year follow-up. Low T5–12 TK on lateral view fulcrum bending films (immediate postoperative odds ratio [OR], 0.870; 95% confidence interval [CI], 0.826–0.917; 2-year postoperative OR, 0.916; 95% CI, 0.876–0.959; p<0.001) and high convex side implant density (2-year postoperative OR, 1.749; 95% CI, 1.056–2.897; p=0.03) were significant risk factors for postoperative hypokyphosis. Other baseline demographic and surgical factors did not affect postoperative kyphosis correction. The T5–12 TK cutoff on fulcrum bending for 2-year postoperative hypokyphosis was 12.45° (area under the curve, 0.773; 95% CI, 0.661–0.820). Conclusions Fulcrum bending radiography is useful in assessing coronal and sagittal flexibility for preoperative planning. In patients with T5–12 kyphosis <12.5° on lateral view fulcrum bending radiographs, Ponte osteotomies or releases, or a decrease in convex side implant density should be considered to improve kyphosis restoration and reduce the risk of 2-year postoperative hypokyphosis.

ObjectiveTo analyze the trend of lung cancer incidence in Fenghua District, Ningbo City of Zhejiang Province from 2009 to 2023, and to estimate the age-period- cohort effects of incidence rate, so as to provide scientific basis for the formulation of lung cancer prevention and control measures in Fenghua District. MethodsJoinpoint software was utilized to analyze the trends and calculate the average annual percentage change (AAPC) of lung cancer incidence based on the tumor incidence surveillance data from Fenghua District, 2009‒2023. The age-period-cohort (APC) model for lung cancer incidence was analyzed using STATA 17.0 software, and net drift and local drift of lung cancer incidence rates were analyzed using online analytical tools. ResultsThe incidence of lung cancer in Fenghua District showed an overall upward trend from 2009 to 2023, with the standardized incidence rate increasing from 45.05/100 000 in 2009 to 108.20/100 000 in 2023(AAPC=7.05%, P<0.05). The increase in the standardized incidence rate for females (AAPC=12.72%, P<0.05) was higher than that for males (AAPC=2.97%, P<0.05). The overall net drift in lung cancer incidence for residents of Fenghua District was 11.71%, with the net drift for females (16.54%) being higher than that for males (6.64%). The local drift in lung cancer incidence among different age groups ranged from -3.37% to 35.18%. The results of APC model showed that the risk of lung cancer incidence increased and then decreased with age, with the highest age effect coefficient observed in the 65‒69 years age group at 1.08. The period effect showed a gradually increasing trend in lung cancer incidence risk with the progression of time, and the period effect coefficient in 2019‒2023 (0.46) was higher than that in 2009‒2013 (-0.39), increasing by 217.95%. The cohort effect coefficient showed a trend of first decreasing and then increasing with the expansion of the birth cohort, in which the lowest cohort effect coefficient was -1.07 observed in the birth cohort of 1964‒1968 and the highest cohort effect coefficient was 1.77 in the birth cohort of 1924‒1928. ConclusionThe incidence of lung cancer in Fenghua District shows an upward trend from 2009 to 2023, with a higher increase in incidence rates among females than that in males. The risk of lung cancer incidence exists a trend of increasing and then decreasing with age growth. With the progression of time, the risk of lung cancer incidence shows a gradually increasing trend. However, with the expansion the birth cohort, the risk of lung cancer incidence demonstrates a trend of first decreasing and then increasing.

Objective To investigate the value of extracellular volume fraction(ECV)based on CT for predicting macrotrabecular-massive hepatocellular carcinoma(MTM-HCC).Methods Data of 23 MTM-HCC(MTM-HCC group)and 56 non-MTM-HCC(nMTM-HCC group)patients were retrospectively analyzed,and CT manifestations were compared between groups.CT values of abdominal aorta(P-CTabdominal aorta,E-CTabdominal aorta),tumors(P-CTtumor,E-CTtumor)and non-tumor liver parenchyma(P-CTliver,E-CTliver)in plain phase(P)and enhancement equilibrium phase(E)CT were measured,then ECV of tumors and liver parenchyma were calculated,and ECV-related parameters were compared between groups.Receiver operating characteristic curves were drawn,and area under the curve(AUC)was calculated to evaluate the predictive efficacy of ECV-related parameters for predicting MTM-HCC.Results No significant difference of CT manifestations was found between groups(all P＞0.05).E-CTtumor,Δltumor(absolute enhancement CT value of the tumor area)and ECVtumor in MTM-HCC group were all lower than those in nMTM-HCC group(all P＜0.01).The AUC of E-CTtumor,Δtumor and ECVtumor for predicting MTM-HCC was 0.74,0.77 and 0.87,respectively,and the AUC of ECVtumor was higher than that of E-CTtumor and Δtumor(Z=2.271,2.557,P=0.023,0.011).Conclusion ECV based on CT could be used to effectively predict MTM-HCC.

Objective To assess the safety of transeptal puncture(TSP)guided by transthoracic echocardiography(TEE)in percutaneous transcatheter closure of patent foramen ovale(PFO).Methods From March 2022 to December 2022,our department performed TSP guided by TEE in 45 patients with PFO who were unable to pass through the PFO with transcatheter standard technique.After guiding the delivery of the sheath,the foramen ovale was occluded.Results PFO closure with TSP technique guided by transthoracic echocardiography was successfully finished in all the 45 patients,with an operative time of(15.0±3.7)min.No complications such as arrhythmia or cardiac perforation happened immediately and at 12 h after surgery.All the patients recovered and were discharged on the next day after surgery.All the 45 patients were followed up by outpatient echocardiography and dynamic electrocardiogram at 3 months after surgery,and no complications such as intracardiac shunt,pericardial effusion,atrial fibrillation,aortic regurgitation,or arrhythmia were observed.Conclusion TSP guided by TEE is safe and feasible,and it can be used as a supplementary method for complex PFO.

Objective:To explore the feasibility of adjusting the thyroid stimulating hormone (TSH) cut-off values for screening congenital hypothyroidism (CH) in newborns according to the seasons, and to establish a TSH screening cut-off value that is suitable for the actual situation in Quanzhou City.Methods:A total of 355 868 newborns who underwent CH screening at the Neonatal Disease Screening Center in Quanzhou in Fujian Province from January 1, 2018 to December 31, 2021 were included in the study. Heel blood samples were collected and made dried blood spots. TSH levels in the heel blood of newborns were measured using genetic screening processor (GSP). The TSH cut-off values for CH screening were established using the percentile method and the receiver operating characteristic (ROC) curve method, and were adjusted based on seasonal factors. The screening efficiency was then compared with the current TSH cut-off value (9.00 mU/L).Results:According to the percentile method, the 99th percentile TSH levels in newborn heel blood in spring, summer, autumn, and winter were 9.47, 9.01, 9.41, and 10.43 mU/L, respectively. Using these values as cut-off values, the initial screening positive rates in spring, summer, autumn, and winter were 1.00% (848/84 652), 1.04% (913/87 524), 1.00% (951/94 875), 1.00% (889/88 817) [1.27% (1 077/84 652), 1.05% (916/87 524), 1.23% (1 171/94 875), 2.01% (1 787/88 817) according to the current TSH cut-off value]. However, except for summer, there were 7, 6, and 17 cases of missed screening in spring, autumn, and winter, respectively. The cut-off values of TSH for the four seasons obtained by the ROC curve method were 9.01, 9.02, 9.01, and 9.01 mU/L, respectively. The initial screening positive rates in spring, autumn, and winter were consistent with the current cut-off values, at 1.27% (1 074/84 652), 1.23% (1 167/94 875), 2.01% (1 781/88 817), respectively, while in summer, it was 0.99% (866/87 524) [1.05% (916/87 524) according to the current TSH cut-off value], and the positive detection rates in all four seasons were 100.00%.Conclusions:It is not advisable to adjust the TSH cut-off value for CH screening according to seasons in Quanzhou City. Using the current TSH cut-off value of 9.00 mU/L for CH screening in Quanzhou City can effectively ensure the quality of screening.

This article introduced the basic theory of non-parametric regression and its application in medical and public health research for methodological reference.We conducted Cox proportional hazard models with restricted cubic splines using chronic disease management data from a Center for Disease Control and Prevention.We aimed to explore the separate and combined effects of mean fasting blood glucose level and glucose variability on all-cause mortality among individuals with type 2 diabetes.A non-linear association was observed between glucose variability and the risk of all-cause mortality.The association between glucose variability and all-cause mortality was stronger at higher mean fasting blood glucose levels compared to lower levels.The non-parametric regression methods comprehensively explored dose-response relationships between continuous exposure and outcome,revealing the combined effects of continuous exposures,which provided recommendations for targeted interventions.The method showed promising application value in medical and public health research.

Giant extralobar pulmonary sequestration in newborns is still relatively rare in pulmonary diseases, and there are few relevant studies published. A neonate with the giant extralobar pulmonary sequestration accompanied by severe pleural effusion was reported here. After 12 days of birth, the diseased lung tissue was surgically extracted. The patient had an uneventful postoperative recovery and was discharged from the hospital. The case shows the advantage of early surgical treatment to extralobar pulmonary sequestration with severe pleural effusion in neonatal period.