ObjectiveTo explore the diagnostic value of plasma C-C motif chemokine ligand 3（CCL3） levels in infectious diseases. MethodsThe study enrolled patients in hospital or outpatient service and individuals undergoing health check-ups at Guangdong Provincial People's Hospital from July to October 2023. Patients clinically diagnosed with infectious diseases were assigned to the experimental group， while those who were healthy or diagnosed with non-infectious diseases were included in the control group. After non-qualifying samples were excluded， residual blood specimens from complete blood count （CBC） tests were collected to measure the plasma CCL3 levels.The CBC parameters including white blood cell count （WBC）， neutrophils count （NEUT）， eosinophils count （EOS），etc， and the plasma CCL3 levels were analyzed between the infectious and control groups to evaluate the clinical diagnostic value of CCL3 in infectious diseases. ResultsA total of 257 cases were enrolled， with 167 in the experimental group （active infections confirmed via clinical symptoms， CBC， inflammatory markers， or etiological examinations） and 90 in the control group （confirmed absence of active infections）. The experimental group exhibited higher levels of WBC， NEUT and CCL3 than the control group， while the lymphocytes count（LYMPH）， EOS in the experimental group were lower， with statistical significance （P<0.001） in univariate analysis. By using these significantly different indicators as independent variables， logistics regression modeling identified WBC， NEUT and CCL3 as independent risk factors for infection. Receiver operating characteristic（ROC） curve analysis revealed superior diagnostic performance of CCL3 over WBC and NEUT， while LYMP and EOS showed no diagnostic performance. The area under the curve （AUC） for CCL3 was 0.844 （95% CI： 0.795， 0.892）， with a sensitivity of 84.4%， a specificity of 69.8%， and an optimal threshold of 106.405 ng/mL. ConclusionPlasma CCL3 levels have clinical diagnostic value in predicting infectious diseases and may serve as a potential clinical biomarker for detecting infectious diseases.

Objective:To investigate the optimal processing technology for Sophorae Fructus Carbonisata(char-coal-processed immature fruit of Sophora japonica)by integrating thermal analysis,response surface methodology(RSM),and intelligent sensory technology.Methods:The thermal analysis technology was used to simulate the processing process of traditional Chinese medicine(TCM),the pyrolysis characteristics of Sophorae Fructus powder were studied,and the processing process was discussed by intelligent sensory analysis to determine the temperature range.Using the contents of genistein,kaempferol,and quercetin as comprehensive evaluation indices,the RSM was applied to optimize the processing technology for Sophorae Fructus Carbonisata.Results:The optimal process-ing technology for Sophorae Fructus Carbonisata was identified as:Stir-frying temperature was 290 ℃,Stir-frying time was 14 min.Conclusion:The integrated approach of thermal analysis-RSM and intelligent sensory technology has successfully established an accurate predictive model for active components in Sophorae Fructus.The optimized processing technology not only enhances the reproducibility of charcoal processing but also lays a foundation for the formulation of national quality standards for this TCM.

Objective:To evaluate the early outcomes of total hip arthroplasty (THA) and discuss the revisions post THA in the treatment for Kashin-Beck disease (KBD) with severe hip problems.Methods:This retrospective cohort study enrolled 50 patients (64 hips) with a mean age of 52.4±8.7 years, including 25 male patients and 25 female patients (36 left hips and 28 right hips), who were diagnosed as KBD with hip problems and received THA at Arthritis Clinical and Research Centre, Peking University People's Hospital from October 2019 to January 2024. The leg length discrepancy (LLD), femoral offset (FO), abduction angle and anteversion angle were calculated preoperatively and one week post-operation. The postoperative radiological indexes and the functional outcomes in the last follow-up were compared with the preoperative assessment.Results:The surgical duration was 105(80, 120) min and the bleeding amount was 300(200, 400) ml. All the cases were followed up for an average of 37 months (ranging from 21 to 44 months). Significant differences were found on postoperative radiological images, with LLD improving to 0.50±0.78 cm from a preoperative value of -1.36±0.79 cm, and FO increasing to 3.28±1.01 cm from 2.72±0.83 cm ( P<0.05). The mean postoperative abduction angle and anteversion angle were 42.5°±7.7° and 15.1°±5.9°, respectively. A total of 71.8% and 95.3% hips fell within the Lewinnek safe zones of abduction angle and anteversion angle, respectively. In terms of functional outcomes, the average range of motion improved significantly to 185°(173°, 210°) from a preoperative value of 99°(76°, 123°), and the Harris Hip Score increased from 35(26, 43) preoperatively to 70(63, 80) postoperatively ( P<0.05). During the follow-up, there were complications for two cases of femoral stem loosening, one case of periprosthetic femoral fracture, one case of hip dislocation, and one case of acetabular component loosening with hip subluxation. Additionally, seven patients exhibited Trendelenburg gait. A total of five hips required revision surgery due to severe complications, including two cases of femoral stem loosening, one case of periprosthetic femoral fracture, one case of hip dislocation, and one case of acetabular component loosening with subluxation. Conclusions:Patients with KBD demonstrated significant early improvements in both radiological and functional outcomes following THA.

Objective:To explore the clinical treatment principles for tibial plateau fracture related infection (TPFRI).Methods:A retrospective study was used to analyze the clinical data of 47 patients with TPFRI who had been admitted to The Third Hospital of Hebei Medical University from May 2015 to May 2022. There were 33 males and 14 females, with an age of (49.3±9.5) years. By admission, 32 tibial plateau fractures got healed while 15 ones remained unhealed. According to the site of infection, TPFRI was classified into 3 categories: arthritic type (9 cases), adjacent articular type (28 cases), and distal articular type (10 cases). Individualized reconstruction plans were made according to fracture union, bone and soft tissue defects, and infection involvement of the knee joint. The knee function was assessed by the modified Hospital for Special Surgery (HSS) criteria at the final follow-up. The fracture union and complications were recorded.Results:All patients were followed up for (37.4±11.7) months. The infection was controlled and the fractures got united after (4.6±1.4) months in the 15 patients whose tibial plateau fractures remained unhealed by admission. In the 32 cases whose tibial plateau fractures got healed by admission (except for the 7 cases without bone defects, 1 case undergoing femoral condyle amputation and 1 case undergoing tibial flip amputation), respectively, Masquelet technique was used in 5 cases, Ilizarov bone transport in 3 cases, filling with an astrocnemius muscle flap or a myocutaneous flap in 5 cases, semi-open bone grafting in 1 case, open bone cement rod technique in 1 case, platelet-rich plasma combined with negative pressure drainage in 1 case, and knee arthrodesis in 7 cases to reconstruct their bone and soft tissue defects. At the final follow-up, the knee function was evaluated based on the modified HSS scoring as excellent in 28 cases, as good in 15 cases, as moderate in 3 cases and as poor in 1 case. The number of the patients with excellent or good knee function was significantly larger in the adjacent articular type and distal articular type than in the arthritic type ( P<0.05). The number of the patients with excellent or good knee function was significantly larger in those whose tibial plateau fractures remained unhealed by admission than in those whose tibial plateau fractures got healed by admission ( P<0.05). All patients did not experience such complications as open fat liquefaction, bone nonunion, lower limb deep vein thrombosis, or pulmonary embolism. Conclusions:In the treatment of TPFRI, individualized treatment plans should be made to improve infection control, accelerate functional recovery of the knee joint, and reduce incidence of complications, taking into consideration such factors as fracture union, bone and soft tissue defects, and infection involvement of the knee joint.

Osteoarthritis,the most common degenerative musculoskeletal disease,has an increasingly heavy burden around the world.In 2019,approximately 530 million people suffered from osteoarthritis,with the age-standardized incidence rate of 492.2 per 100 000,the age-standardized prevalence rate of 6348.3 per 100 000 and the age-standardized rate of disability-adjusted life years(DALYs)of 228.0 per 100 000.The heaviest burden is observed in high-income North America while the fastest growth of burden is observed in high-income Asia Pacific.The age-standardized rate of incidence,prevalence and DALYs in China were 509.8 per 100 000,6330.1 per 100 000 and 224.8 per 100 000,respectively,which were higher than the average level in Asia.Considering the large and aging population in China,the disease burden will continue to increase and the prevalent number and DALYs in 2044 are expected to be 1.5 times higher than those in 2019.Although osteoarthritis is frequently seen in the elderly,the negative impact on young adults should not be ignored.Besides,postmenopausal women,individuals with high body mass index,and residents in rural and mountainous areas are also at relatively higher risk of osteoarthritis.Osteoarthritis increases the risk of multiple diseases,in-cluding cardiovascular diseases,diabetes and psychological cognitive impairment,as well as the sarcopenia and fractures.The increasing disease burdens and medical requirements in China indicate that clinicians have to fully understand the burden and harm of the disease,and conduct initial screening and intervention for the oste-oarthritis-related diseases for patients.The long-term goal is to relieve the disease burdens and to improve the quality of life for osteoarthritis patients.

Objective: To examine the effect of intracellular vesicles (IVs) and extracellular vesicles (EVs) that originated from periodontal ligament stem cells (PDLSCs) on the osteogenic differentiation of PDLSCs within a lipopolysaccharide (LPS)-simulated inflammatory microenvironment, and to provide new insights for the application of IVs in the repair and regeneration of periodontal tissue in periodontitis. Methods: Ethical approval was obtained from the institution. Human-origin PDLSCs were extracted, and the IVs and EVs from PDLSCs at the 3rd-6th passages were gathered and identified using transmission electron microscopy, nano flow cytometry (Nano FCM) analysis, and Western Blot. The 3rd-6th generations of PDLSCs were categorized into the following groups: Control group, LPS group, LPS + 100 μg/mL EVs group (LPS+EVs group), and LPS + 100 μg/mL IVs group (LPS+IVs group). The effects of the IVs and EVs on the anti-inflammatory and osteogenic differentiation of PDLSCs in an inflammatory microenvironment were assessed by using a Cell Counting Kit-8 (CCK-8), enzyme-linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (qRT-PCR), Western Blot, alkaline phosphatase (ALP) staining, and alizarin red staining (ARS). Results: Under transmission electron microscopy, the IVs and EVs derived from PDLSCs displayed a double-layer membrane structure. NanoFCM analysis revealed that the average diameters of the IVs and EVs were 79.6 nm and 82.1 nm, respectively. Western Blot analysis indicated that the surface proteins CD9, CD63, and CD81 of the IVs and EVs were positively expressed, while calnexin was negatively expressed, indicating that IVs and EVs were successfully obtained. Compared with the Control group, the proliferation of PDLSCs in the LPS group was reduced, while the levels of inflammatory cytokine interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the cell supernatant were increased, the mRNA expressions of osteogenic differentiation-related genes, including osteoblast-related genes runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteocalcin (OCN) of PDLSCs were reduced, the protein expressions of RUNX2 and osteopontin (OPN) were also decreased (P<0.05); compared with the LPS group, the proliferation of PDLSCs in the LPS+EVs group and LPS+IVs group were significantly increased, while the levels of IL-6, TNF-α were significantly reduced, and the mRNA expressions of RUNX2, ALP, OCN were significantly increased, the protein expressions of RUNX2 and OPN were also significantly increased (P<0.05). Further, in the inflammatory microenvironment, Compared with EVs, IVs more significantly promote the proliferation of PDLSCs, inhibit TNF-α expression, enhance the expression of RUNX2 mRNA, upregulate the expression of RUNX2 and OPN proteins, increase ALP activity, and promote the formation of mineralized nodules (P<0.05). Conclusion IVs and EVs derived from PDLSCs can boost the proliferation of PDLSCs in an inflammatory microenvironment, inhibit the expression of inflammatory factors, and advance the osteogenic differentiation of PDLSCs. The anti-inflammatory and osteogenic effects of IVs are superior to those of EVs.

Objective:To analyze the differences between subjective refraction and autorefraction in myopic children and adolescents under different ciliary muscle functional states.Methods:A cohort study was conducted.A total of 98 myopic children and adolescents (196 eyes) aged 7-15 years who visited the Shanghai Eye Disease Prevention and Treatment Center from November 2023 to February 2024 were included by random sampling.All participants underwent cycloplegia with 1.0% cyclopentolate and completed both subjective refraction and autorefraction before cycloplegia, after cycloplegia and after recovery from cycloplegia.The spherical equivalent (SE) differences and differences in SE(ΔSE) between different conditions were compared.Proportion of ΔSE, differences in spherical power (ΔS), and differences in cylindrical power (ΔC) of objective and subjective refraction between different conditions within the clinically acceptable error range (-0.25 to 0.25 D) was calculated and compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shanghai Eye Diseases Prevention & Treatment Center (No.2021SQ021).Written informed consent was obtained from guardian of each subject before any medical examination.Results:The SE values obtained from autorefraction before cycloplegia, after cycloplegia, and after recovery from cycloplegia were -2.44(-3.47, -1.63), -2.13(-3.25, -1.50), and -2.38(-3.50, -1.66)D, respectively, with a statistically significant overall difference ( χ2=148.36, P<0.001) and statistically significant differences in pairwise comparisons at different time points (all P<0.001); for subjective refraction, the SE values were -2.25(-3.50, -1.50), -2.19(-3.47, -1.45), and -2.28(-3.50, -1.50)D, respectively, with a statistically significant overall difference ( χ2=43.48, P<0.001) and statistically significant differences in pairwise comparisons at different time points (all P<0.001).Subjective refraction ΔSE between before and after cycloplegia, after cycloplegia and after recovery from cycloplegia were significantly smaller than those of autorefraction ( t=2.84, 1.82; both P<0.001).There was no significant difference in ΔSE between subjective refraction and autorefraction between before cycloplegia and after recovery from cycloplegia ( t=-0.43, P=0.070).The proportions of subjective refraction ΔSE within the acceptable error range between before and after cycloplegia, before cycloplegia and after recovery from cycloplegia, and after cycloplegia and after recovery from cycloplegia were significantly higher than those of autorefraction ( χ2=28.32, 11.82, 25.55; all P<0.001).The proportion of subjective refraction ΔS and ΔC both within the acceptable error range between before cycloplegia and after recovery from cycloplegia was 81.63%(160/196) and 79.59%(156/196) between after cycloplegia and after recovery from cycloplegia. Conclusions:Subjective refraction is less affected by different ciliary muscle functional states.The differences in subjective refraction results under different ciliary muscle functional states are mostly within the acceptable error range.The subjective refraction results before or after cycloplegia can be used to better predict the subjective refraction results after recovery from cycloplegia.

Smart healthcare plays an important role in easing the strain on medical resources and improving the continuity of chronic disease management. This study analysed the iatrogenic risks from the intrinsic attributes and the external environment of smart healthcare, including doctor-patient conflict risk, technical operation risk, information leakage risk, humanistic absence risk, legal risk, regulatory risk and ethical risk. Based on the " structure process result" model, suggestions were proposed to optimize the construction of a smart healthcare platform for chronic diseases, improve the legal system and industry standards, strengthen talent cultivation and capacity building, establish an integrated regulatory system, and regularly evaluate the effectiveness of chronic disease management. These suggestions provided references for creating a healthy, orderly, and safe smart healthcare environment for chronic disease patients.

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

[Objective]Patients with hepatic glycogen storage disease(GSD)have recurrent episodes of hypoglycemia.This study aimed to investigate and analyze blood glucose and biochemical indicators in pediatric patients with hepatic GSD,thus provide data support for hypoglycemia prevention and its clinical management.[Methods]A cross-sectional field study was conducted among patients with hepatic GSD treated in the Department of Pediatrics of Guangdong Provincial People's Hospital on July 14,2024.We collected the peripheral blood samples of the patients and their healthy family controls on site,then analyzed and compared their blood glucose and biochemical indicators.[Results]Of the 44 patients with hepatic GSD,there were 34 males and 10 females,including GSD Ib(n=14),GSD Ia(n=15),GSD Ⅲ(n=2),GSD Ⅵ(n=7)and GSD Ⅸ(n=6).The average age was 7.60(5.08-11.98)years.All patients were on uncooked cornstarch(UCCS)therapy.Of the patients,77.3%(34/44)had hepatomegaly,61.4%(27/44)had recurrent hypoglycemia,61.4%(27/44)had blood glucose≤3.9 mmol/L,18.2%(8/44)had blood glucose≤2.8 mmol/L,and none of the 8 cases was GSD Ib.The lowest blood glucose level was 1.19 mmol/L and no episodes of hypoglycemia occurred.Of the family control subjects,65.9%(29/44)had blood glucose≤3.9 mmol/L.There was no significant difference in hypoglycemia prevalence between hepatic GSD group and control group(P=0.658).The hepatic GSD patients had hyperlactacemia,hyperuricemia and hypercholesterolemia prevalence rates of 65.9%,45.5%and 9.1%,respectively,as compared with 18.2%,43.2%and 15.9%,respectively,for the family control subjects.No significant difference was found in the prevalence rates of hyperuricemia and hypercholesterolemia between the two groups(P=0.830 and P=0.334,respectively).[Conclusions]Asymptomatic hypoglycemia is common in patients with hepatic GSD,especially in non-GSD-Ib patients.It is necessary to optimize the diet management of UCCS,conduct dynamic blood glucose monitoring and follow a light diet,so as to decrease hyperuricemia and hypercholesterolemia,avoid and reduce the serious adverse reactions and complications caused by severe hypoglycemia.