BACKGROUND:Currently,research both domestically and internationally on patellofemoral pain syndrome has explored the kinematics and dynamics during daily activities such as stair ascent and descent,and walking. However,there is a lack of studies examining the lower limb biomechanical characteristics of young female patients with patellofemoral pain syndrome in different squatting conditions.OBJECTIVE:To investigate the lower limb biomechanical characteristics among young female patients with patellofemoral pain syndrome in different functional states of the subtalar joint,providing theoretical support for the clinical treatment of various types of patellofemoral pain syndrome.METHODS:A total of 33 participants were included in this study. There were 10 subjects in the healthy control group (group C). The other 27 subjects with patellofemoral pain syndrome were divided into two groups according to the foot posture index:14 subjects in the normal subtalar joint group (group A,foot posture index 0-6 points) and 13 subjects in the abnormal subtalar joint group (group B,foot posture index 7-12 points). The biomechanical indices of thesubjects in each group were collected and compared when they walked on stairs at normal speed. The kinematic indices included the three-dimensional joint angles of the hip and knee and the sagittal plane joint angles of the ankle at the initial contact moment and the moment of maximum knee flexion angle during the stance period. The dynamic indices included the three-dimensional joint torques of the hip and knee and the sagittal plane joint torques of the ankle at the moment of maximum knee flexion angle during the stance period. The surface electromyography indices included the root mean square amplitudes of the vastus medialis,vastus lateralis,rectus femoris,semitendinosus and semimembranosus,biceps femoris,and gluteus medius in the pre-activation stage and the buffering stage.RESULTS AND CONCLUSION:(1) At the initial ground contact moment,group A exhibited a greater knee flexion angle (P<0.05),greater hip external rotation angle (P<0.01),and smaller knee external rotation angle (P<0.01) compared to group B. Compared to group C,group A showed a greater knee flexion angle and smaller hip flexion angle (both P<0.01). Group B demonstrated a greater knee external rotation angle and smaller hip external rotation angle and hip flexion angle (all P<0.01) compared to group C. (2) At the moment of maximum knee flexion,group A had a smaller knee valgus angle (P<0.05),smaller knee external rotation angle (P<0.05),and greater knee flexion angle (P<0.01) compared to group B. Compared to group C,group A showed a smaller knee valgus angle (P<0.05),smaller hip flexion angle (P<0.01),and smaller hip external rotation angle (P<0.05). Group B had a smaller knee flexion angle,hip flexion angle,hip external rotation angle,and greater knee external rotation angle (all P<0.01) compared to group C. Additionally,group A exhibited a greater hip internal rotation moment (P<0.05) and plantarflexion moment (P<0.01) compared to group C. (3) At normal speed during the staircase buffering phase,group C showed higher activation levels than group A in the vastus lateralis (P<0.05),vastus medialis (P<0.01),gluteus medius (P<0.01),and biceps femoris (P<0.05). Group C also had higher activation levels than group B in the vastus medialis (P<0.01),gluteus medius (P<0.01),and biceps femoris (P<0.05). Additionally,group A showed higher activation in the semitendinosus and semimembranosus muscles compared to group B (P<0.05). (4) These findings indicate that young female patients with patellofemoral pain syndrome have stiffer hip and knee joint buffering while descending stairs,potentially compensated by the ankle joint. Low muscle activation levels contribute to patellofemoral pain,with those having normal subtalar joints but experiencing pain showing the lowest and most abnormal activation. ③ Abnormal biomechanics in the normal subtalar joint group are mainly due to insufficient hip and knee flexion. Abnormal biomechanics in the abnormal subtalar joint group are mainly due to excessive subtalar joint pronation.

Objective:To investigate the application effect of web-based problem-based learning (WPBL) versus traditional teaching in the teaching of geriatric medicine courses.Methods:PubMed, Embase, the Cochrane Library, Web of Science, CNKI, CBMdisc, and Wanfang Data were searched for clinical studies on the application of WPBL in the teaching of geriatric medicine courses in China and globally published up to October 1, 2023. After literature screening, data extraction, and quality assessment, RevMan5.4.1 was used to perform a systematic review.Results:A total of 14 eligible articles were included in this study, with 1 436 medical students as the subjects and geriatric medicine as the content of teaching. The Meta-analysis showed that WPBL teaching had a better effect than traditional problem-based learning or lecture-based learning in the teaching of geriatric medicine courses and could improve the theoretical examination score [mean difference (MD)=3.53, 95% confidence interval (CI)=1.77-5.29, P<0.001], operational skills (MD=5.92, 95%CI=2.67-9.18, P<0.001), critical thinking ability (MD=9.30, 95%CI=5.43-13.18, P<0.001), and teaching satisfaction (MD=1.75, 95%CI=1.49-2.01, P<0.001) among medical students. Conclusions:WPBL in the teaching of geriatric medicine courses can improve the theoretical examination score, operational skills, critical thinking skills, and teaching satisfaction among medical students.

Objective:To verify the applicability of the flight potential evaluation system in the psychological selection of pilots by testing the reliability and validity of the system.Methods:Between September and October 2021, 82 subjects, including 32 pilots and 50 volunteers, were recruited from the Aviation Force and the Air Force Medical Center to complete the flight potential evaluation system test. The pilots and volunteers were divided into the high score group (the top 27% in terms of scores) and low score group (the 27% from the bottom) according to the total score of the evaluation. In order to ensure the consistency of evaluation conditions, some subjects were selected to complete a second evaluation test one week later for reliability analysis. Six flight experts completed the Content Evaluation Form of the Flight Potential Evaluation System while the officer completed the Flight Performance Evaluation Questionnaire as the performance data of the pilots. The pass rates of the pilots and volunteers and discriminability of the flight potential evaluation system were analyzed to test the stability and effectiveness of the system.Results:①The flight potential evaluation system demonstrated a pass rate of 0.75 and a discriminability of 0.30 in pilots, compared with 0.30 and 0.51 in volunteers. The total scores of pilots and volunteers were (7.00±1.16) points and (3.38±2.15) points, respectively, with a statistically significant difference ( t=9.87, P<0.001). Significant differences were found in test scores between high-score group and low-score group for both pilots ( t=10.01, P<0.001) and volunteers ( Z=-4.65, P<0.001). ②Thirty-seven subjects (including 32 pilots and 5 volunteers, all from the Aviation Force) were tested twice, and the Pearson product-moment correlation coefficient for the paired results of 2 identical tests was r=0.750 ( P<0.001). ③As for the content of the evaluation system test, the experts′ degree of agreement and unanimity rate were 1. The evaluation score by the officer was positively correlated with the test score ( r=0.389, P=0.041). Conclusions:The flight potential evaluation system has a strong ability to distinguish flight-related abilities, suggesting that the system can be applied to the psychological selection of pilots and provide data for subsequent tests during the recruitment of candidates.

Objective:To explore the impact of intermittent oro-esophageal tube feeding (IOE) on the nutritional status and prognosis of patients with dysphagia after acute ischemic stroke.Methods:Using the convenience sampling method, 210 patients with dysphagia after acute ischemic stroke who were treated at The Second Affiliated Hospital of Wenzhou Medical University from May 2020 to May 2022 were selected as the research objects. The patients were divided into an observation group ( n=108) and a control group ( n=102) by the coin-tossing method. The control group was intervened with indwelling nasogastric tube method, while the observation group was treated with IOE. The clinical efficacy, nutritional indicators, scores of the Activities of Daily Living (ADL) Scale, and the incidence of complications were compared between the two groups. Results:After the intervention, the total effective rate of the observation group was higher than that of the control group, and the levels of albumin, pre-albumin, and hemoglobin in the observation group were higher than those in the control group, and the incidence of complications was lower than that of the control group. The differences were all statistically significant ( P<0.05) . Conclusions:For patients with acute ischemic stroke, IOE can improve the symptoms of dysphagia, enhance their nutritional level, and also reduce the incidence of complications.

ObjectiveTo explore the coercive experience of involuntarily hospitalized adolescents with mental disorders during the admission process and hospitalization， providing references for formulating targeted nursing interventions. MethodsSemi-structured interviews were conducted with 15 involuntarily hospitalized adolescents with mental disorders selected from October to December 2023， and the themes were summarized and extracted by content analysis. ResultsA total of 3 themes and 10 sub-themes were extracted， which were used to elaborate the essential contents， causes， and improvement methods of coercive experience. These encompassed the multi-dimensional content of coercive experience （complex emotional experience， different physical sensations， and contradictory cognitive evaluation）， the multi-faceted causes of coercive experience （insufficient personal preparation， inadequate parental communication， and strict medical management system）， as well as the phased improvement of coercive experience （adequate communication before hospitalization， patient notification before coercive intervention， respecting for demands during coercive intervention， and comforting explanation after coercive intervention）. ConclusionThe essential content of the coercive experience of involuntarily hospitalized adolescents with mental disorders is complex and has various causes， which require cooperation from multiple parties to improve. Therefore， parents should respect the expression of their children’s self-will， and medical staff should respect patients’ autonomy， establishing a protection-constrained doctor-patient relationship model and collaborating to reduce the use of coercive interventions， to improve the overall medical satisfaction of adolescents with mental disorders.

Objective:To investigate the dynamic changes of plasma high-mobility group box 1 (HMGB1) and its correlation with functional outcome and symptomatic intracranial hemorrhage (sICH) after endovascular treatment (EVT) in patients with acute large vessel occlusion stroke (ALVOS).Methods:Patients with ALVOS admitted to the Department of Neurology, Zengcheng District, Nanfang Hospital, Southern Medical University from June 2021 to April 2023 were included retrospectively. Plasma HMGB1 before EVT and at 6, 24, and 48 hours after procedure was detected, and the dynamic changes of plasma HMGB1 were compared and analyzed. The primary endpoint was the functional outcome evaluated using the modified Rankin Scale at 90 days of onset. A score of 0-2 was defined as good outcome and >2 was defined as poor outcome. The secondary endpoint was sICH, which was defined as the occurrence of hemorrhagic infarction after EVT and an increase of ≥4 in the National Institutes of Health Stroke Scale (NIHSS) score from baseline. Multivariate logistic regression analysis was used to evaluate the predictive value of HMGB1 for poor outcome and sICH. Results:A total of 73 patients with ALVOS received EVT were included. There were 54 males (74.0%), aged 62±12 years. The median time from onset to door was 90 minutes (interquartile range, 40-180 minutes), and the median time from onset to femoral artery puncture was 181 minutes (interquartile range, 140-280 minutes). Twenty-nine patients (39.7%) underwent bridging intravenous thrombolysis (IVT). At 90 days after onset, 37 patients (50.7%) had poor outcome, and 12 (16.4%) died during follow-up. Eleven patients (15.1%) developed sICH. After EVT, plasma HMGB1 showed a temporal increase, reaching its peak at 48 hours (median, 102.57 μg/L). Subgroup analysis showed that HMGB1 in the bridging IVT group at 6 hours ( P<0.05) and 24 hours ( P<0.05) after procedure were significantly higher than that at baseline. The non-bridging IVT group showed a significant increase at 6 hours after procedure ( P<0.05). There was no statistically significant difference in HMGB1 between the bridging IVT group and the non-bridging IVT group at the same time point. Multivariate logistic regression analysis showed that after adjusting for age, ischemic heart disease, triglycerides, uric acid, baseline NIHSS score, and sICH, the third quartile (adjusted odds ratio 7.087, 95% confidence interval 1.243-40.419; P=0.027) and fourth quartile (adjusted odds ratio 7.544, 95% confidence interval 1.260-45.172; P=0.027) of plasma HMGB1 were independent risk factors for poor outcome at 6 hours after procedure. The postoperative plasma HMGB1 in the sICH group was significantly higher than that in the non-sICH group ( P<0.05), but multivariate analysis showed no independent correlation between plasma HMGB1 and sICH. Conclusion:The elevation of plasma HMGB1 in patients with ALVOS at 6 hours after EVT is independently associated with poor outcome at 90 days after onset, but not with sICH.

Abstract The global prevalence of non-suicidal self-harm (NSSI) among adolescents is becoming increasingly severe. Traditional mental health services are struggling to meet the growing social demand due to limited resource allocation and service accessibility. The rapid development of artificial intelligence (AI) technology provides a new technological path. The article systematically reviews the research progress of AI technology in adolescent NSSI, demonstrating key technologies such as machine learning, natural language processing, and deep learning in predicting NSSI risk prediction, emotion recognition and online intervention for adolescents. However, challenges remain, including algorithm bias, data privacy protection, model interpretability and ethical decision making. Future research should focus on multi disciplinary collaborative cooperation based on artificial intelligence to build a safe, effective and sustainable digital psychological intervention system, so as to provide innovative strategies and technical support for the early warning and intervention of NSSI behavior in adolescents.

OBJECTIVES: To investigate the changes in blood levels of calcium and bone metabolism biochemical markers in patients with primary osteoporosis receiving treatment with denosumab. METHODS: Seventy-three patients with primary osteoporosis treated in our Department between December, 2021 and December 2023 were enrolled. All the patients were treated with calcium supplements, vitamin D and calcitriol in addition to regular denosumab treatment every 6 months. Blood calcium, parathyroid hormone (PTH), osteocalcin (OC), type I procollagen amino-terminal propeptide (PINP), and type I collagen carboxy-terminal telopeptide β special sequence (β‑CTX) data before and at 3, 6, 9, and 12 months after the first treatment were collected from each patient. RESULTS: Three months after the first denosumab treatment, the bone turnover markers (BTMs) OC, PINP, and β-CTX were significantly decreased compared to their baseline levels by 39.5% (P<0.001), 56.2% (P<0.001), and 81.8% (P<0.001), respectively. At 6, 9, and 12 months of treatment, OC, PINP, and β-CTX remained significantly lower than their baseline levels (P<0.001). Blood calcium level was decreased (P<0.05) and PTH level increased (P<0.05) significantly in these patients at months of denosumab treatment, but their levels were comparable to the baseline levels at 6, 9, and 12 months of the treatment (P>0.05). CONCLUSIONS Denosumab can suppress BTMs and has a good therapeutic effect in patients with primary osteoporosis, but reduction of blood calcium and elevation of PTH levels can occur during the first 3 months in spite of calcium supplementation. Blood calcium and PTH levels can recover the baseline levels as the treatment extended, suggesting the importance of monitoring blood calcium and PTH levels during denosumab treatment.
Humans ; Denosumab/therapeutic use* ; Calcium/blood* ; Parathyroid Hormone/blood* ; Biomarkers/blood* ; Osteoporosis/blood* ; Osteocalcin/blood* ; Procollagen/blood* ; Female ; Collagen Type I/blood* ; Peptide Fragments/blood* ; Bone Density Conservation Agents/therapeutic use* ; Bone and Bones/metabolism* ; Male ; Middle Aged ; Vitamin D ; Peptides/blood* ; Aged

Objective:To evaluate the safety and efficacy of mild hypothermia arch-clamping technique in the surgical treatment of DeBakey Type Ⅰ aortic dissection.Methods:From December 2019 to November 2023, a total of 97 patients with DeBakey type Ⅰ aortic dissection who underwent arch-clamping technique in Beijing Anzhen Hospital were prospectively enrolled. The patients were divided into mild hypothermia group and moderate hypothermia group according to the lowest rectal temperature during the circulatory arrest period. The perioperative data of the two groups were compared, and complex adverse outcomes consisting of 30-day death, stroke, paraplegia and CRRT were used as the primary endpoint. Multivariate logistic regression was used to determine the predictors of clinical adverse outcomes. Survival analysis was evaluated by the Kaplan- Meier method. Results:The overall incidence of complex adverse outcomes was 20.6%, 13.6% in the mild hypothermia group and 22.7% in the moderate hypothermia group( P=0.535), and the incidence of stroke was 4.6% and 6.7%( P=1.000), respectively. The cardiopulmonary bypass time and aortic-clamping time in the mild hypothermia group were significantly shortened (147.5 min vs. 163.0 min, P=0.032; 89 min vs. 99 min, P=0.042). There was no significant difference in long-term survival and reintervention between the two groups(91.9% vs. 89.3%, P=0.87; 9.1% vs. 5.3%, P=0.13). Conclusion:Mild hypothermia arch-clamping technique is a safe and effective method for the treatment of DeBakey type Ⅰ aortic dissection, with satisfactory short-term and long-term efficacy.

Objective To investigate the plaque characteristics evaluated by intravascular ultrasound(IVUS)in perimenopausal women with coronary artery disease(CAD)and their impacts on the outcomes of stent implantation.Methods A total of 169 female CAD patients who were admitted to the Fourth People's Hospital of Langfang City from March 2021 to March 2023 were selected as research objects.All the patients underwent coronary angiography(CAG)and IVUS to identify plaque characteristics.Based on the plaque stability,the patients were assigned to stable plaque group(n=105)or unstable plaque group(n=64).Clinical data,IVUS parameters,coronary stent placement,and the incidence of major adverse cardiac events(MACE)were compared between the two groups.Results The plaque burden in the unstable plaque group was higher than that in the stable plaque group,while the minimal lumen area in the unstable plaque group was lower than that in the stable plaque group(P<0.05).The incidences of thrombosis,plaque rupture,and calcification in the unstable plaque group were higher than those in the stable plaque group(P<0.05).The stent placement rate and achievement rate in the unstable plaque group were higher than those in the stable plaque group(P<0.05).Kaplan-Meier survival analysis showed that the incidence of MACE in the unstable plaque group was significantly higher than that in the stable plaque group(HR=2.257,95%CI:1.184-4.303,log-rank P=0.007).Conclusion IVUS shows high value in evaluating plaque characteristics in perimenopausal women with CAD.It can be used as an important tool to optimize treatment strategies.