Objective To investigate the influence of repeated open field tests， novel object recognition tests， and Barnes maze behavioral tests within a short term on cognitive and anxiety assessment in 3xTg-AD mice.Methods Four groups of 3xTg-AD mice， aged 12 months， were obtained using different pretreatment regimens， and the mice in the experimental groups 1-3 were treated with different drugs， while those in the control group were treated with normal saline. The open field test， the novel object recognition test， and the Barnes maze test were performed on mice successively. A behavioral video analysis system was used to record the locomotor trajectories of the mice and analyze the parameters such as time spent in the central area， exploration time for novel versus familiar objects， and latency to reach the target hole. After one session of complete tests， three sessions were performed repeatedly， and all tests were completed within one month.Results With the increase in the number of repeated tests， there was a significant reduction in the time spent in the central area in the open field test （P<0.05）； in the novel object recognition test， there was an increase in the coefficient of variation for object recognition index and a reduction in exploratory behavior towards both the new environment and the novel objects； in the Barnes maze test， there was no significant difference in the latency to reach the target hole across the four tests， suggesting good reproducibility.Conclusion Repeated tests within a short term can interfere with the evaluation of anxiety status in 3xTg-AD mice in the open field test and their preference for novel objects in the novel object recognition test， but it has no obvious influence on the latency to reach the target hole in the Barnes maze test. Whether behavioral tests can be performed repeatedly in 3xTg-AD mice should be determined based on different tests.

ObjectiveTo explore the effects of the Tai Chi training on bone density， bone turnover markers， and heart rate variability for people with high-risk osteoporosis， and to provide evidence for the prevention of osteoporosis at early stage. MethodsSixty-six cases of people with high risk of osteoporosis were included， and they were divided into 33 cases each in the intervention group and the control group using the random number table method. The control group received osteoporosis health education three times a week， and the intervention group received Tai Chi training under the guidance of a trainer three times a week for 40 mins each time on the basis of the control group， and both groups were intervened for 12 weeks. Dual-energy X-ray absorptiometry was used to measure the bone density of L₁~L₄ vertebrae， bilateral femoral necks and bilateral total hips in the two groups before and after the intervention； enzyme-linked immunosorbent assay was used to determine bone turnover markers before and after the intervention， including pro-collagen type Ⅰ pro-amino-terminal prepropyl peptide （P1NP） and β-collagen type Ⅰ cross-linking carboxy-terminal peptide （β-CTX）. Seven cases with good compliance in the intervention group were selected. After wearing the heart rate sensor， they successively performed Tai Chi training and walking activities recommended by the guideline for 20 mins each， and the heart rate variability （HRV） during exercise was collected， including time-domain indexes such as standard deviation of normal sinus intervals （SDNN）， root-mean-square of the difference between adjacent RR intervals （RMSSD）， frequency-domain metrics such as low-frequency power （LF）， high-frequency power （HF）， and low-frequency/high-frequency power ratio （LF/HF）， as well as nonlinear metrics such as approximate entropy （ApEn）， sample entropy （SampEn）. ResultsFinally， 63 cases were included in the outcome analysis， including 30 cases in the intervention group and 33 cases in the control group. After the intervention， the differences of L₁~L₄ vertebrae， bone density of bilateral femoral neck and bilateral total hip in the intervention group were not statistically significant when compared with those before intervention （P＞0.05）， while the bone density of all parts of the control group decreased significantly compared with that before intervention （P＜0.05）， and the difference in the bone density of the L₁~L₄ vertebrae， bilateral femoral neck， and the right total hip before and after the intervention of the intervention group was smaller than that of the control group （P＜0.05）. The differences in P1NP and β-CTX between groups before and after intervention was not statistically significant （P＞0.05）. Compared with walking exercise， LF decreased， HF increased and LF/HF decreased during Tai Chi exercise （P＜0.05）； the time domain indexes and non-linear indexes between groups had no statistically significant difference （P＞0.05）. ConclusionTai Chi exercise can maintain lumbar， hip， and femoral bone density and improve sympathetic/parasympathetic balance in people at high risk for osteoporosis， but cannot significantly improve bone turnover markers.

OBJECTIVE: To investigate the feasibility and clinical outcomes of emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery. METHODS: A retrospective analysis was conducted of 10 patients with traumatic dynamic muscle defects treated between March 2020 and April 2024. There were 8 males and 2 females, aged 23-52 years (mean, 36.7 years). Injuries included 7 cases of Gustilo type ⅢB forearm trauma (2 with flexor muscle group defects, 3 with extensor muscle group defects, and 2 with combined flexor and extensor muscle group defects), 1 case of right first metacarpal defect with concomitant thenar muscle and skin defect, 1 case of complete transection of the right upper arm musclecutaneous nerve extracted from the biceps brachii muscle, and 1 case of Gustilo type ⅢC lower-limb trauma with extensor hallucis longus and toe extensor defects. Soft tissue defects ranged from 10 cm×8 cm to 36 cm×11 cm. Preoperative musculoskeletal ultrasound of the contralateral side was used to measure cross-sectional area, length, and pennation angle of the target muscles. Based on these parameters, anterolateral thigh flaps combined with one or two superficial vastus lateralis muscle segments were designed and transplanted to the recipient sites. The grafts were used to cover wounds, reconstruct major missing muscle groups, and were fixed in place. Vascular and neural anastomoses were performed simultaneously with repair of bone and soft tissue injuries to restore limb perfusion and function. Postoperative evaluation included musculoskeletal ultrasound, electrophysiology, and dynamic assessment of muscle strength during follow-up. RESULTS: All transplanted muscles and flaps survived primarily without vascular or neural complications. All the 10 patients were followed up 10-38 months, with an average of 22.8 months. The muscle strength recovery reached M₅ in 6 cases, M₄ in 3 cases, and M3+ in 1 case. Patients achieving M₄ or above regained their original work capacity; limb contours were symmetrical, with no joint deformities, and patients achieved effective ranges of motion; functional recovery included the ability to push or lift weights of 2-30 kg, perform opposition, and achieve grasping function. All flaps were soft and lustrous, and the protective sensation restored in all patients. There was no discomfort in the donor site and knee joint. Musculoskeletal ultrasound showed that the average cross-sectional area of the transplanted muscles increased by 4%-66% in 10 cases at 1 month after operation, and the ratio of the average cross-sectional area of the transplanted muscles in contraction and relaxation was 1.37±0.16 in 7 cases at 6 months after operation. Electrophysiological examination showed that motor potential could be detected in 8 cases at 2 months after operation, and then the amplitude increased gradually, and 2 cases were not detected. CONCLUSION Emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery achieves near-normal muscle strength recovery and effective joint motion. This technique allows for reconstruction of one or two major muscle groups as clinically required.
Humans ; Male ; Adult ; Female ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Middle Aged ; Quadriceps Muscle/transplantation* ; Femoral Artery/surgery* ; Young Adult ; Muscle, Skeletal/surgery* ; Treatment Outcome ; Forearm Injuries/surgery*

ObjectiveTo unveil the mechanism of Jianpi Huogu prescription （JPHGP） in ameliorating the dyslipidemia of steroid-induced osteonecrosis of the femur head （SONFH） by oxylipidomics combined with transcriptomics. MethodsSixty SD rats were assigned into normal， model， low-， medium-， and high-dose （2.5， 5， 10 g·kg^-1， respectively） JPHGP， and Jiangushengwan （1.53 g·kg^-1） groups. Lipopolysaccharide was injected into the tail vein at a dose of 20 μg·kg^-1 on days 1 and 2， and methylprednisolone sodium succinate was injected at a dose of 40 mg·kg^-1 into the buttock muscle on days 3 to 5. The normal group received an equal volume of normal saline. Drug administration by gavage began 4 weeks after the last injection， and samples were taken after administration for 8 weeks. Hematoxylin-eosin staining was conducted to reveal the histopathological changes of the femoral head， and the number of adipocytes， the rate of empty bone lacunae， and the trabecular area were calculated. Micro-computed tomography was used for revealing the histological and histomorphometrical changes of the femoral head. Enzyme-linked immunosorbent assay was employed to measure the serum levels of triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein （LDL）， high-density lipoprotein （HDL）， apolipoprotein A1 （ApoA1）， and apolipoprotein B （ApoB）. At the same time， the femoral head was collected for oxylipidomic and transcriptomic detection. The differential metabolites and differential genes were enriched and analyzed， and the target genes regulating lipid metabolism were predicted. The predicted target proteins were further verified by molecular docking， immunohistochemistry， and Western blot. ResultsCompared with the normal group， the model group showcased thinning of the femoral head， trabecular fracture， karyopyknosis， subchondral cystic degeneration， increases in the number of adipocytes and the rate of empty bone lacunae （P<0.01）， a reduction in the trabecular area （P<0.01）， decreases in BMD， Tb.Th， Tb.N， and BV/TV， and increases in Tb.Sp and BS/BV （P<0.01）. Compared with the model group， the JPHGP groups showed no obvious thinning of the femoral head or subchondroidal cystic degeneration. The high- and medium-dose JPHGP groups presented declines in the number of adipocytes and the rate of empty bone lacunae， an increase in the trabecular area （P<0.05， P<0.01）， rises in BMD， Tb.Th， Tb.N， and BV/TV， and decreases in Tb.Sp and BS/BV （P<0.05， P<0.01）. Compared with the normal group， the model group showcased raised serum levels of TG， TC， LDL， and ApoB and lowered serum levels of HDL and ApoA1 （P<0.01）. Compared with the model group， the JPHGP groups had lowered serum levels of TG， TC， LDL， and ApoB （P<0.05， P<0.01） and a risen serum level of ApoA1 （P<0.05， P<0.01）. Moreover， the serum level of HDL in the high-dose JPHGP group increased （P<0.01）. A total of 19 different metabolites of disease set and drug set were screened out by oxylipidomics of the femoral head， and 119 core genes with restored expression were detected by transcriptomics. The enriched pathways were mainly concentrated in inflammation， lipids， apoptosis， and osteoclast differentiation. Molecular docking， immunohistochemistry， and Western blot results showed that compared with the normal group， the model group displayed increased content of 5-lipoxygenase （5-LO） and peroxisome proliferator-activated receptor γ （PPARγ） in the femoral head （P<0.01）. Compared with the model group， medium- and high-dose JPHGP reduced the content of 5-LO and PPARγ （P<0.05， P<0.01）. ConclusionJPHGP can restore the levels of oxidized lipid metabolites by regulating the 5-LO-PPARγ axis to treat SONFH in rats. Relevant studies provide experimental evidence for the efficacy mechanism of JPHGP in the treatment of SONFH.

ObjectiveTo unveil the mechanism of Jianpi Huogu prescription （JPHGP） in ameliorating the dyslipidemia of steroid-induced osteonecrosis of the femur head （SONFH） by oxylipidomics combined with transcriptomics. MethodsSixty SD rats were assigned into normal， model， low-， medium-， and high-dose （2.5， 5， 10 g·kg^-1， respectively） JPHGP， and Jiangushengwan （1.53 g·kg^-1） groups. Lipopolysaccharide was injected into the tail vein at a dose of 20 μg·kg^-1 on days 1 and 2， and methylprednisolone sodium succinate was injected at a dose of 40 mg·kg^-1 into the buttock muscle on days 3 to 5. The normal group received an equal volume of normal saline. Drug administration by gavage began 4 weeks after the last injection， and samples were taken after administration for 8 weeks. Hematoxylin-eosin staining was conducted to reveal the histopathological changes of the femoral head， and the number of adipocytes， the rate of empty bone lacunae， and the trabecular area were calculated. Micro-computed tomography was used for revealing the histological and histomorphometrical changes of the femoral head. Enzyme-linked immunosorbent assay was employed to measure the serum levels of triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein （LDL）， high-density lipoprotein （HDL）， apolipoprotein A1 （ApoA1）， and apolipoprotein B （ApoB）. At the same time， the femoral head was collected for oxylipidomic and transcriptomic detection. The differential metabolites and differential genes were enriched and analyzed， and the target genes regulating lipid metabolism were predicted. The predicted target proteins were further verified by molecular docking， immunohistochemistry， and Western blot. ResultsCompared with the normal group， the model group showcased thinning of the femoral head， trabecular fracture， karyopyknosis， subchondral cystic degeneration， increases in the number of adipocytes and the rate of empty bone lacunae （P<0.01）， a reduction in the trabecular area （P<0.01）， decreases in BMD， Tb.Th， Tb.N， and BV/TV， and increases in Tb.Sp and BS/BV （P<0.01）. Compared with the model group， the JPHGP groups showed no obvious thinning of the femoral head or subchondroidal cystic degeneration. The high- and medium-dose JPHGP groups presented declines in the number of adipocytes and the rate of empty bone lacunae， an increase in the trabecular area （P<0.05， P<0.01）， rises in BMD， Tb.Th， Tb.N， and BV/TV， and decreases in Tb.Sp and BS/BV （P<0.05， P<0.01）. Compared with the normal group， the model group showcased raised serum levels of TG， TC， LDL， and ApoB and lowered serum levels of HDL and ApoA1 （P<0.01）. Compared with the model group， the JPHGP groups had lowered serum levels of TG， TC， LDL， and ApoB （P<0.05， P<0.01） and a risen serum level of ApoA1 （P<0.05， P<0.01）. Moreover， the serum level of HDL in the high-dose JPHGP group increased （P<0.01）. A total of 19 different metabolites of disease set and drug set were screened out by oxylipidomics of the femoral head， and 119 core genes with restored expression were detected by transcriptomics. The enriched pathways were mainly concentrated in inflammation， lipids， apoptosis， and osteoclast differentiation. Molecular docking， immunohistochemistry， and Western blot results showed that compared with the normal group， the model group displayed increased content of 5-lipoxygenase （5-LO） and peroxisome proliferator-activated receptor γ （PPARγ） in the femoral head （P<0.01）. Compared with the model group， medium- and high-dose JPHGP reduced the content of 5-LO and PPARγ （P<0.05， P<0.01）. ConclusionJPHGP can restore the levels of oxidized lipid metabolites by regulating the 5-LO-PPARγ axis to treat SONFH in rats. Relevant studies provide experimental evidence for the efficacy mechanism of JPHGP in the treatment of SONFH.

Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective To investigate the impact of new-onset atrial fibrillation(AF)on all-cause mortality in elderly patients with hypertension having no previous history of AF.Methods A retrospective study was conducted on 1352 elderly hypertensive inpatients who had no history of AF and received long-term follow-up in Chinese PLA General Hospital from January 2014 to June 2017.According to having newly developed AF or not,they were divided into a new-set AF group(191 cases)and a control group(1161 cases).Kaplan-Meier survival curve was plotted for survival analysis and multivariate Cox survival analysis was performed to identify risk factors for all-cause mortality.Results Compared with the control group,the new-onset AF group exhibited significantly advanced age,higher urea level,lower diabetes ratio,and decreased hemoglobin level(P＜0.05,P＜0.01).Kaplan-Meier survival curve analysis showed that the cumulative mortality of the new-onset AF group was significantly higher than that of the control group(P＜0.01).Multivariate Cox regression analysis revealed that age＞75 years(HR=4.562,95％CI:3.104-6.705,P＜0.01),anemia(HR=2.543,95％CI:1.939-3.334,P＜0.01),new-onset AF(HR=1.494,95％CI:1.185-1.884,P＜0.01),eGFR＜60 mL/(min·1.73 m2)(HR=1.729,95％CI:1.389-2.151,P＜0.01),and heart failure(HR=1.539,95％CI:1.173-2.019,P＜0.01)were risk factors for all-cause mortality in elderly hypertensive patients without a history of AF.Conclusions New-onset AF is closely associated with an increased risk of all-cause mortality in elderly hypertensive patients without a previous history of AF.

Objective:To investigate the prognostic and predictive value of tertiary lymphoid structures (TLS) in gastric cancer patients undergoing immunotherapy.Methods:Clinical and pathological data, along with tumor tissue samples, were collected from 33 gastric cancer patients who received immunotherapy at Zhongda Hospital, Southeast University from January 2020 to December 2024. The density of tertiary lymphoid structures (TLS) and expression patterns of CD3, CD20, PNAd, and BCL6 were systematically evaluated using hematoxylin-eosin (H&E) staining and immunohistochemical (IHC) analysis. Statistical analyses were performed to determine the associations between TLS characteristics and clinical outcomes, including objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS).Results:Patients in the TLS-high infiltration group (TLS High) demonstrated significantly better outcomes compared to that of the TLS-low group (TLS Low), with higher ORR (58.8% vs 18.8%, P=0.019), DCR (94.1% vs 37.5%, <0.001), and markedly prolonged median PFS (276 vs 67 days, P＜0.000 1). Similarly, the BCL6-high expression group (BCL6 High) showed superior treatment responses versus the BCL6-low group (BCL6 Low), with significantly higher ORR (64.7% vs 12.5%, P=0.002), DCR (100.0% vs 31.3%, P＜0.001), and extended PFS ( P＜0.001). Univariate and multivariable Cox regression confirmed TLS infiltration level as an independent favorable prognostic factor for gastric cancer patients receiving immunotherapy ( HR=0.147, 95% CI: 0.022-0.964, P=0.046). Receiver operating characteristic (ROC) curve analysis revealed excellent predictive accuracy for both TLS infiltration [area under the curve (AUC)=0.885, P＜0.001] and the BCL6 scoring model (AUC=0.890, P＜0.001) in anticipating immunotherapy response. Conclusion:TLS density and BCL6 expression may serve as dual predictive and prognostic biomarkers for gastric cancer immunotherapy, highlighting their clinical utility in patient stratification and treatment guidance.

Objective:To analyze the efficacy of arthroscopic release of the lateral patellofemoral retinaculum (LPR) combined with medial patellofemoral ligament (MPFL) compression for the treatment of moderate to severe patellofemoral arthritis.Methods:A prospective study method was used to select 101 patients with moderate to severe patellofemoral arthritis who were admitted to the Jinzhou Medical University Shanghai Fengxian District Central Hospital from January 2021 to December 2023. They were randomly divided into group A (50 cases, LPR release surgery under knee arthroscopy) and group B (51 cases, LPR release surgery combined with MPFL compression surgery under knee arthroscopy). Perioperative indexes, pain degree of patellofemoral joint, patellofemoral trajectory correction, knee joint function and patellofemoral joint function were compared between the two groups before and 6 months after surgery.Results:During the study period, both group A and group B were excluded or separated, and ultimately 47 and 49 patients were enrolled in group A and group B, respectively. The operation time of group B was longer than that of group A: (35.27 ± 3.09) min vs. (25.64 ± 2.66) min, with statistically significant differences ( P<0.05). Six months after surgery, both groups experienced a reduction in pain, with group B being milder than group A: no pain 75.51% (37/49) vs. 44.68% (21/47), mild pain 24.49% (12/49) vs. 38.30% (18/47), moderate pain 0 vs. 14.89% (7/47), and severe pain 0 vs. 2.13% (1/47). The difference was statistically significant ( P<0.05). Six months after surgery, the patellofemoral adaptation angle, patellofemoral tilt angle, and patellofemoral lateral displacement distance in both groups decreased, and group B was smaller than group A: (8.02 ± 1.62)° vs. (10.35 ± 1.54)°, (8.71 ± 1.08)° vs. (10.85 ± 0.75)°, 1.00 (1.00, 1.00) mm vs. 1.00 (1.00, 1.00) mm, with statistically significant differences ( P<0.05). Both groups showed an increase in Lysholm knee score scale and patellar Kujala score, with group B being higher than group A: (89.92 ± 4.02) points vs. (84.21 ± 5.65) points and (89.18 ± 2.57) points vs. (87.40 ± 3.38) points, with statistically significant differences ( P<0.05). Conclusions:Arthroscopic release of LPR combined with MPFL compression surgery is more effective in treating moderate to severe patellofemoral arthritis than arthroscopic release of LPR. It can improve the correction of patellofemoral trajectory, reduce pain, and facilitate the recovery of knee and patellar joint function.

Objective:This study introduces a novel segmented and layered thoracic laminoplasty technique for the treatment of thoracic spinal stenosis (TSS) caused by ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF). The goal is to simplify the surgical procedure, improve safety, reduce iatrogenic injuries, and validate its clinical outcomes through follow-up.Methods:A retrospective analysis was conducted on 23 patients (10 males, 13 females; mean age 58.83±12.01 years) treated at Taizhou People's Hospital Affiliated to Nanjing Medical University from January 2018 to December 2023. Transverse grooves were created at the superior and inferior vertebral pedicle levels, utilizing the intervertebral ligamentum flavum as a segmental demarcation reference. Partial removal of the distal lamina and medial of the inferior articular process was performed through a cortical window. Under direct visualization, complete removal of ossified ligamentum flavum, proximal portion of lamina, superior articular process. The treatment effect was evaluated by clinical symptoms, signs, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), imaging results (CT and MRI) and complications before or after surgery.Results:All 23 procedures were successfully completed with a mean operative duration of 180(150, 220) min, the surgical time for 71 segments were 67.5(53.8, 120.0) minutes and intraoperative blood loss of 200(100, 300) ml, demonstrating a low intraoperative dural tear rate of 8.70% (2/23). Postoperative imaging (CT/MRI) confirmed adequate decompression in all cases, with significant symptom improvement at final follow-up 21(9, 39) months: 47% (7/15) of patients achieved marked relief of lower limb numbness, 82% (14/17) showed substantial motor recovery, and 54% (7/13) exhibited improved gait stability. Functional outcomes revealed significant enhancements, with JOA scores increasing from 8(6, 8) preoperatively to 9(8, 10) postoperatively ( P<0.05; 43.80% improvement rate) and VAS scores decreasing from 6(5, 7) to 2(1, 4) ( P<0.05). The complications were two dural tears and one suture reaction. Conclusions:Ultrasonic osteotome-assisted segmented layered laminectomy is a safe, effective, and straightforward technique for treating thoracic spinal stenosis caused by OPLL and OLF. It offers shorter operative times, minimal complications, and significant clinical improvement, making it a promising technique for broader clinical adoption.