Based on a review of classical literature combined with modern anatomical and biomechanical research， this paper proposes the "four intersections" of channel sinew diseases from the perspective of structural interfaces， which involves sinew-bone， sinew-sinew， sinew-joint， and sinew-vessel intersections， and analyzes the corresponding pathological characteristics. It is believed that the dynamic evolution of channel sinew diseases can be summarized as "starting with mechanical imbalancew， with interface transmission as the pivot， compensation continuation as the variation， and neurological adaptation as the consolidation". Furthermore， the pathological changes at the "four intersections" structural interfaces correspond respectively to clinical manifestations of enthesial pain， referred pain， joint dysfunction and sensory abnormalities. Understanding channel sinew diseases based on the "four intersections" structural interface is conducive to deepening the understanding of the pathogenesis， thereby providing a reference for clinical identification and precise treatment.

This paper introduces chief physician of traditional Chinese medicine WANG Yigang's clinical experience in treating peripheral facial palsy in the acute stage with acupuncture-medication-combined therapy.Professor WANG believes that the pathogenesis of facial paralysis in the early stage is mostly the external invasion of wind and pathogenic toxins and the internal disturbance of dampness and toxins,resulting in the obstruction of collaterals and muscle regions of meridians.The treatment should be guided by the"unity of form(body)and spirit(Shen)",paying attention to the movement of the spirit,dispelling evils,and regulating the spirit.Professor WANG believes that when the spirit initiates,the healthy Qi is strong,and the pathogen subsides.In the treatment,he is good at combining acupuncture and medication for a synergistic effect,stresses the use of scalp points,and coins the empirical point Miandong(Extra).At the same time,he does not restrict himself to the traditional needling method and treats facial paralysis with"dynamic retention acupuncture".

Obesity has become a global public health challenge,and metabolic and bariatric surgery(MBS)remains one of the most effective treatments for severe obesity.However,substantial variability in patient characteristics,surgical complexity,and postoperative adherence leads to heterogeneous outcomes.The rapid evolution of artificial intelligence(AI)offers new opportunities to address these limitations.By integrating multidimensional clinical,imaging,and longitudinal follow-up data,machine learning and large language models support key aspects of MBS,including candidate selection,surgical decision-making,perioperative risk prediction,skill assessment,and long-term outcome management.Recent studies have demonstrated notable progress in decision support,complication forecasting,robotic surgery optimization,patient counselling,and postoperative weight-trajectory prediction.Nevertheless,challenges remain regarding model generalizability,ethical and regulatory oversight,data privacy,and transparency in AI-assisted decision-making.This review summarizes current advances,limitations,and future directions of AI applications in MBS,providing a reference for clinicians seeking to understand and apply these emerging technologies.

Obesity has become a global public health challenge,and metabolic and bariatric surgery(MBS)remains one of the most effective treatments for severe obesity.However,substantial variability in patient characteristics,surgical complexity,and postoperative adherence leads to heterogeneous outcomes.The rapid evolution of artificial intelligence(AI)offers new opportunities to address these limitations.By integrating multidimensional clinical,imaging,and longitudinal follow-up data,machine learning and large language models support key aspects of MBS,including candidate selection,surgical decision-making,perioperative risk prediction,skill assessment,and long-term outcome management.Recent studies have demonstrated notable progress in decision support,complication forecasting,robotic surgery optimization,patient counselling,and postoperative weight-trajectory prediction.Nevertheless,challenges remain regarding model generalizability,ethical and regulatory oversight,data privacy,and transparency in AI-assisted decision-making.This review summarizes current advances,limitations,and future directions of AI applications in MBS,providing a reference for clinicians seeking to understand and apply these emerging technologies.

This paper introduces chief physician of traditional Chinese medicine WANG Yigang's clinical experience in treating peripheral facial palsy in the acute stage with acupuncture-medication-combined therapy.Professor WANG believes that the pathogenesis of facial paralysis in the early stage is mostly the external invasion of wind and pathogenic toxins and the internal disturbance of dampness and toxins,resulting in the obstruction of collaterals and muscle regions of meridians.The treatment should be guided by the"unity of form(body)and spirit(Shen)",paying attention to the movement of the spirit,dispelling evils,and regulating the spirit.Professor WANG believes that when the spirit initiates,the healthy Qi is strong,and the pathogen subsides.In the treatment,he is good at combining acupuncture and medication for a synergistic effect,stresses the use of scalp points,and coins the empirical point Miandong(Extra).At the same time,he does not restrict himself to the traditional needling method and treats facial paralysis with"dynamic retention acupuncture".

BACKGROUND:Poor incision healing and infection often occur in elderly patients with lateral malleolar fractures after traditional lateral plate fixation.With the application of engineering software in medicine,a new type of plate placed posterolateral can be designed to solve the above-described problems. OBJECTIVE:To design a new type of posterior lateral low-profile steel plate with the aid of medical bioengineering software,based on the 3D CT data of the distance between the top of the lateral ankle fracture line to the anterior starting point(ACD),the distance between the top of the fracture line to the tip of the lateral ankle(CTD),the distance between the top of the fracture line to the posterior edge of the fracture line(PCD)and the angle between the anterior and posterior lateral sides of the distal fibula(CA). METHODS:Thirty cases of unstable lateral malleolar fracture and normal ankle were taken for CT scanning and three-dimensional reconstruction.The ACD,CTD,and PCD values in patients with lateral malleolar fracture were measured by 3-matic software,and the characteristics of lateral malleolar fracture line were plotted and described.The mimics software was used to measure the value of CA in the normal ankle joint.Based on the data measured above,3-matic software and solidworks software were used to design the low-profile steel plate and the thickness of the steel plate and the direction of the nail path were constructed.In Geomagic Studio software,fine surface,automatic surface,and fitting surface were used to generate the prototype of the low-profile steel plate,and then 3D printing was performed.After making a posterolateral incision of the lateral malleolus,the peroneus longus and brevis tendons were removed,and the prototype of the 3D-printed steel plate was placed behind the fibula to test its size and fit to the bone surface. RESULTS AND CONCLUSION:(1)The mean of ACD was(2.97±0.03)cm,and the variation was 5.23.The mean of PCD was(3.17±0.11)cm,and the variation was 17.60.The mean of CTD was(4.52±0.07)cm,and the variation was 8.60.(2)The fracture line of the lateral malleolus was drawn with an inverted"V"shape.The mean of CA between anterior and posterior lateral surfaces of the distal fibula was(103.20±1.94)°.At the midpoint section of the upper and lower vertices of the anterior edge of the distal fibula,the angle of the anterior and posterior lateral sides(CA)of the distal fibula was(78.50±1.78)°.(3)By using 3-matic,Solidworks,and Geomagic Studio software,a new type of posterior lateral low-profile steel could be successfully designed.Three to four holes were reserved for the screw holes at the proximal end of the plate with screw directions from back to front,and three screw holes were reserved on the inner and outer sides at the far end.The direction of the inner three holes could be from back to front,and the outer three screw holes needed to be biased towards the inner side,with an angle of 9.72°-13.28°.(4)It is indicated that the variability of the ACD position on the anterior lateral fracture line of the lateral malleolus is relatively small,while the variability of the posterior lateral PCD position is relatively large.The angle between the anterolateral and posterolateral sides of the lateral ankle fracture block shows a decreasing trend,with a smaller variation in the proximal angle and a larger variation in the distal angle.Based on three-dimensional CT reconstruction data of the external ankle,with the help of computer bioengineering software and the use of reverse design concept,a new type of low-profile lateral malleolus steel plate with a good fit can be quickly and conveniently designed to provide a valuable reference for the design of internal fixation devices.

OBJECTIVE: To explore the expression of Exosome Component 4（EXOSC4） in the tissues of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) and its clinical significance. METHODS: The expression of EXOSC4 protein in the tissues of 181 newly diagnosed DLBCL patients was analyzed by immunohistochemical staining. Clinical data were collected. The correlation between EXOSC4 protein expression in the tissues of newly diagnosed DLBCL patients and clinical features were analyzed and its prognostic significance. RESULTS: The positive rate of EXOSC4 protein expression was 68.51% in the tissues of 181 newly diagnosed DLBCL patients. These patients were divided into two groups, with 44 cases in high expression group and 137 cases in low expression group. There were no significant differences in age, gender, B symptoms, serum lactate dehydrogenase (LDH) level, Eastern Cooperative Oncology Group (ECOG) score, Ann Arbor stage, extranodal disease, International Prognostic Index (IPI) score, National Comprehensive Cancer Network IPI (NCCN-IPI) score, and cell origin between the two groups (P>0.05). Cox multivariate regression analysis showed that high EXOSC4 protein expression in tissues was an independent poor prognostic factor for OS and PFS in newly diagnosed DLBCL patients (all P<0.05). K-M survival analysis showed that newly diagnosed DLBCL patients with high EXOSC4 protein expression had significantly shorter overall survival (OS) and progression free survival (PFS) than those patients with low EXOSC4 protein expression (all P<0.05). CONCLUSION High EXOSC4 protein expression in tissues of newly diagnosed DLBCL patients is an independent poor prognostic factor for survival.
Humans ; Clinical Relevance ; Lymphoma, Large B-Cell, Diffuse/pathology* ; Prognosis ; Retrospective Studies ; Exosome Multienzyme Ribonuclease Complex/genetics*

Objective:To investigate the efficacy of a machine learning model based on radiomics of brain lesions on T 2WI in differentiating multiple sclerosis (MS) from neuromyelitis optica spectrum disorders (NMOSD). Methods:Totally 223 MS and NMOSD patients who were treated from January 2009 to September 2018 in Beijing Tiantan Hospital Affiliated to Capital Medical University, Donghu Branch of the First Affiliated Hospital of Nanchang University, Tianjin Medical University General Hospital, and Xuanwu Hospital of Capital Medical University were analyzed retrospectively, and according to the proportion of 7∶3, 223 patients were completely randomly divided into training set (156 cases) and test set (67 cases). A total of 74 patients with MS and NMOSD who were treated in Huashan Hospital Affiliated to Fudan University and China-Japan Friendship Hospital of Jilin University from January 2009 to September 2018 and in Xianghu Branch of the First Affiliated Hospital of Nanchang University from March 2020 to September 2021 were collected as an independent external validation set. All patients underwent brain cross-sectional MR T 2WI, radiomics features were extracted from T 2WI, and features were selected by max-relevance and min-redundancy and least absolute shrinkage and selection operator algorithms. Then various machine learning classifier models (logistic regression, decision tree, AdaBoost, random forest or support vector machine) were constructed to differentiate MS from NMOSD. The area under curve (AUC) of receiver operating characteristics was used to evaluate the performance of each classifier model in the training set, test set and external validation set. Results:Based on multi-center T 2WI, a total of 11 radiomics features related to the discrimination between MS and NMOSD were extracted and classifier models were constructed. Among them, the random forest model had the best efficiency in distinguishing MS from NMOSD, and its AUC values for distinguishing MS from NMOSD in the training set, test set and external validation set were 1.000, 0.944 and 0.902, with specificity of 100%, 76.9% and 86.0%, and sensitivity of 100%, 92.1% and 79.7%, respectively. Conclusion:The random forest model based on the radiomic features of T 2WI of brain lesions can effectively distinguish MS from NMOSD.

Objective:To investigate the changes of glymphatic system function at relapse and remission phases in patients with relapsing remitting multiple sclerosis (RRMS) and their relations with clinical parameters.Methods:Sixteen patients with RRMS at relapsing phase and 25 patients with RRMS at remitting phase, admitted to Department of Neurology, First Affiliated Hospital of Nanchang University from September 2012 to December 2020, were enrolled; and 29 normal controls were recruited at the same period in Physical Examination Center the same hospital. The diffusion tensor imaging data were analyzed retrospectively, and the along perivascular space (ALPS) index was calculated. The differences in clinical data and ALPS index among the 3 groups were compared, and the correlations between ALPS index and clinical parameters in RRMS patients were analyzed.Results:The scores of expanded disability status scale (EDSS) and modified fatigue impact scale (MFIS) in patients at relapsing phase were significantly higher than those in patients at remitting phase ( P<0.05). The ALPS index in bilateral cerebral hemispheres in the control group was significantly higher than that in RRMS patients at relapse and remission phases ( P<0.05). In patients with RRMS at relapse phase, the ALPS index in the left cerebral hemisphere was negatively correlated with disease duration and EDSS scores ( r=-0.536, P=0.032; r=-0.573, P=0.020). Conclusion:Patients with RRMS have glymphatic system dysfunction; this dysfunction may be the potential pathological basis of clinical dysfunction in patients with RRMS at relapsing phase.

Objective To observe the effectiveness of dexmedetomidine on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy.Methods Seventy patients (17 males,53 females,aged 20-65 years,ASA grade Ⅰ or Ⅱ) undergoing laparoscopic cholecystectomy were randomized to receive either dexmedetomidine (group R,n=35) or dexamethasone (group D,n=35).The patients in the group R received 0.5 μg/kg bolus dose and maintenance dose at the rate of 0.5 μg·kg-1·h-1 of dexmedetomidine before intubation.The patients in the group D received 8 mg dexamethasone before intubation.The BP and HR were recorded at the following points: on arrival in the operating room (T1),before intubation (T2),5 minutes after intubation (T3),5 minutes after the beginning of the operation (T4),30 minutes after the beginning of the operation (T5),at the end of operation (T6) and 5 minutes after extubation (T7).The inhaling concentration of sevoflurane,extubation time,operation time and anesthesia time were recorded.The incidence of nausea and vomiting were recorded at 8,24,48 hours after operation.Results The incidence of nausea and vomiting at each point were similar between two groups.The HR at T2-T7 in group D was significantly lower.But MAP was similar between two groups.Conclusion 0.5 μg/kg bolus dose and maintenance dose at the rate of 0.5 μg·kg-1·h-1 of dexmedetomidine reduced the incidence of PONV in patients undergoing laparoscopic cholecystectomy,similar to dexamethasone.