Traditional Chinese medicine(TCM)is an ancient medical system distinctive and effective in treating cancer,depression,coronavirus disease 2019(COVID-19),and other diseases.However,the relatively abstract diagnostic methods of TCM lack objective measurement,and the complex mechanisms of action are difficult to comprehend,which hinders the application and internationalization of TCM.Recently,while breakthroughs have been made in utilizing methods such as network pharmacology and virtual screening for TCM research,the rise of machine learning(ML)has significantly enhanced their inte-gration with TCM.This article introduces representative methodological cases in quality control,mechanism research,diagnosis,and treatment processes of TCM,revealing the potential applications of ML technology in TCM.Furthermore,the challenges faced by ML in TCM applications are summarized,and future directions are discussed.

This consensus will introduce the characteristics of fillers used in the surgical cavities of domestic nasal surgery patients based on relevant literature and expert opinions. It will also provide recommendations for the selection of cavity fillers for different nasal diseases, with chronic sinusitis as a representative example.
Humans ; Nasal Cavity/surgery* ; Nasal Surgical Procedures ; China ; Consensus ; Sinusitis/surgery* ; Dermal Fillers

Traditional Chinese medicine (TCM) is an ancient medical system distinctive and effective in treating cancer, depression, coronavirus disease 2019 (COVID-19), and other diseases. However, the relatively abstract diagnostic methods of TCM lack objective measurement, and the complex mechanisms of action are difficult to comprehend, which hinders the application and internationalization of TCM. Recently, while breakthroughs have been made in utilizing methods such as network pharmacology and virtual screening for TCM research, the rise of machine learning (ML) has significantly enhanced their integration with TCM. This article introduces representative methodological cases in quality control, mechanism research, diagnosis, and treatment processes of TCM, revealing the potential applications of ML technology in TCM. Furthermore, the challenges faced by ML in TCM applications are summarized, and future directions are discussed.

OBJECTIVE: To investigate the accuracy of color Doppler ultrasound (CDU) and CT angiography (CTA) in the preoperative evaluation of perforator vessels in free posterior interosseous artery perforator (PIAP) flaps. METHODS: Between January 2020 and December 2023, 19 patients with hand skin and soft tissue defects caused by trauma were admitted. There were 11 males and 8 females, with a median age of 45 years (range, 26-54 years). The interval between injury and admission was 5-11 days (mean, 7.2 days). The skin and soft tissue defects were located on the dorsum of the hand in 8 cases and on the fingers in 11 cases. The size of defect ranged from 4.0 cm×2.5 cm to 7.5 cm×3.5 cm. After locating the perforator vessels through CDU and CTA before operation, the free PIAP flaps were designed to repair hand defects, with the size of 4.5 cm×3.0 cm-7.5 cm×4.0 cm. The defects of donor sites were directly sutured. The number and diameter of perforator vessels in the posterior interosseous artery detected by CDU and CTA were compared. The differences in localization of perforator vessels using CDU and CTA and their clinical effects were also compared to calculate the accuracy and recognition rate. During follow-up, the survival of the skin flap was observed, and the Vancouver scar scale (VSS) score was used to evaluate the healing of the donor site, while the visual analogue scale (VAS) score was used to evaluate the patient's satisfaction with the appearance of the skin flap. RESULTS: The number and the diameter of PIAP vessels was 5.8±1.2 and (0.62±0.08) mm assessed by CDU and 5.2±1.0 and (0.60±0.07) mm by CTA, showing no significant difference between the two methods ( P>0.05). The number, course, and distribution of perforator vessels of the PIAP vessels observed during operation were basically consistent with those detected by preoperative CDU and CTA. Compared with intraoperative observation results, the recognition rates of dominant perforating vessels by CDU and CTA were 95.0% (18/19) and 89.5% (17/19), respectively, and the accuracy rates were 100% (19/19) and 84.2% (16/19), with no significant difference between the two methods ( P>0.05). All flaps survived after operation, and all wounds and incisions at donor sites healed by first intention. All patients were followed up 6-13 months (mean, 8.2 months). At last follow-up, the skin flaps had elasticity and soft texture，with the patient satisfaction VAS score of 9.2±0.8. The donor sites had no obvious scar hyperplasia with the VSS score of 11.7±0.9. CONCLUSION CDU and CTA accurately identify the dominant perforator vessels and provide reliable information for vessel localization, facilitating precise flap harvesting and minimizing donor site injury. However, CDU offers superior visualization of distal end of perforator vessels in the forearm compared to CTA.
Humans ; Female ; Male ; Adult ; Perforator Flap/blood supply* ; Middle Aged ; Ultrasonography, Doppler, Color/methods* ; Computed Tomography Angiography/methods* ; Soft Tissue Injuries/diagnostic imaging* ; Hand Injuries/diagnostic imaging* ; Plastic Surgery Procedures/methods* ; Hand/surgery* ; Preoperative Care ; Arteries/diagnostic imaging*

BACKGROUND:The role of microRNA-214 in osteoporosis has been reported both at home and abroad,whereas the interrelationship between microRNA-214 and osteoarthritic articular cartilage and subchondral bone degeneration is unclear. OBJECTIVE:To investigate the relationship between microRNA-214 and cartilage and subchondral bone degeneration in mice with knee osteoarthritis. METHODS:Thirty C57BL/6J mice were randomly grouped:Experiment 1:sham operation group and medial meniscus destabilization group (n=3 per group) underwent hematoxylin-eosin staining and qPCR to detect changes in microRNA-214 gene expression;Experiment 2:sham operation group,medial meniscus destabilization group,medial meniscus destabilization+null-loaded adenovirus group (null-loaded group),and medial meniscus destabilization+microRNA-214 antagonist overexpression adenovirus group (antagonist group;n=6 per group). Cartilage tissues were taken from each group 4 weeks after surgery,and stained with hematoxylin-eosin,safranin O-fast green,and toluidine blue. qPCR and western blot were used to detect the expression of related factors in articular cartilage. RESULTS AND CONCLUSION:(1) In Experiment 1,hematoxylin-eosin staining results showed that cartilage degeneration was visible in the medial meniscus destabilization group compared with the sham operation group. qPCR assay results showed that microRNA-214 was expressed in all the samples,and the expression level of microRNA-214 in cartilage samples of the medial meniscus destabilization group was significantly higher than that of the sham operation group (P<0.05). (2) In Experiment 2,the results of hematoxylin-eosin staining,safranin O-fast green staining,and toluidine blue staining showed that the degree of cartilage degeneration in the antagonist group was significantly reduced compared with the medial meniscus destabilization group. Adenovirus-validated PCR assay showed that the microRNA-214 expression level in cartilage tissue was higher in the null-loaded group than in the antagonist group (P<0.05). (3) In Experiment 2,X-ray results showed typical osteoarthritis imaging changes in the medial meniscus destabilization group and null-loaded group,while the degree of degenerative joint lesions was relatively mild in the antagonist group. The results of microcomputed tomography showed that after injection of microRNA-214 antagonist,trabecular structure model index became smaller in the antagonist group,and the data were better than those of the medial meniscus destabilization group and null-loaded group. (4) In Experiment 2,western blot results showed that The relative expression levels of cartilage-associated factor type Ⅱ collagen α1,sex-determining region Y-box 9,Runt-associated transcription factor 2,and osteopontin in cartilage specimens of the medial meniscus destabilization group and the null-loaded group were lower than that in the sham operation group and the antagonist group (P<0.05),whereas the relative expression level of matrix metalloproteinase 13 was higher in the medial meniscus destabilization group and the null-loaded group than the sham operation group and the antagonist group (P<0.05). (5) In Experiment 2,PCR results indicated that the relative mRNA expression of tumor necrosis factor-α and interleukin-6 was relatively higher in the medial meniscus destabilization group and null-loaded group,but relatively lower in the antagonist group,as compared with the sham operation group (P<0.05). The relative mRNA expression of tumor necrosis factor-α and interleukin-6 was also higher in the medial meniscus destabilization group and the null-loaded group compared with the antagonist group (P<0.05). To conclude,the expression level of microRNA-214 in articular cartilage was elevated in the mouse osteoarthritis model,suggesting that the elevated expression level of microRNA-214 is closely related to osteoarthritis;and injection of microRNA-214 antagonist into the knee joint cavity of the mouse osteoarthritis model could delay articular cartilage degradation,promote subchondral bone remodeling,and ameliorate the progression of osteoarthritis.

BACKGROUND:The role of microRNA-214 in osteoporosis has been reported both at home and abroad,whereas the interrelationship between microRNA-214 and osteoarthritic articular cartilage and subchondral bone degeneration is unclear. OBJECTIVE:To investigate the relationship between microRNA-214 and cartilage and subchondral bone degeneration in mice with knee osteoarthritis. METHODS:Thirty C57BL/6J mice were randomly grouped:Experiment 1:sham operation group and medial meniscus destabilization group (n=3 per group) underwent hematoxylin-eosin staining and qPCR to detect changes in microRNA-214 gene expression;Experiment 2:sham operation group,medial meniscus destabilization group,medial meniscus destabilization+null-loaded adenovirus group (null-loaded group),and medial meniscus destabilization+microRNA-214 antagonist overexpression adenovirus group (antagonist group;n=6 per group). Cartilage tissues were taken from each group 4 weeks after surgery,and stained with hematoxylin-eosin,safranin O-fast green,and toluidine blue. qPCR and western blot were used to detect the expression of related factors in articular cartilage. RESULTS AND CONCLUSION:(1) In Experiment 1,hematoxylin-eosin staining results showed that cartilage degeneration was visible in the medial meniscus destabilization group compared with the sham operation group. qPCR assay results showed that microRNA-214 was expressed in all the samples,and the expression level of microRNA-214 in cartilage samples of the medial meniscus destabilization group was significantly higher than that of the sham operation group (P<0.05). (2) In Experiment 2,the results of hematoxylin-eosin staining,safranin O-fast green staining,and toluidine blue staining showed that the degree of cartilage degeneration in the antagonist group was significantly reduced compared with the medial meniscus destabilization group. Adenovirus-validated PCR assay showed that the microRNA-214 expression level in cartilage tissue was higher in the null-loaded group than in the antagonist group (P<0.05). (3) In Experiment 2,X-ray results showed typical osteoarthritis imaging changes in the medial meniscus destabilization group and null-loaded group,while the degree of degenerative joint lesions was relatively mild in the antagonist group. The results of microcomputed tomography showed that after injection of microRNA-214 antagonist,trabecular structure model index became smaller in the antagonist group,and the data were better than those of the medial meniscus destabilization group and null-loaded group. (4) In Experiment 2,western blot results showed that The relative expression levels of cartilage-associated factor type Ⅱ collagen α1,sex-determining region Y-box 9,Runt-associated transcription factor 2,and osteopontin in cartilage specimens of the medial meniscus destabilization group and the null-loaded group were lower than that in the sham operation group and the antagonist group (P<0.05),whereas the relative expression level of matrix metalloproteinase 13 was higher in the medial meniscus destabilization group and the null-loaded group than the sham operation group and the antagonist group (P<0.05). (5) In Experiment 2,PCR results indicated that the relative mRNA expression of tumor necrosis factor-α and interleukin-6 was relatively higher in the medial meniscus destabilization group and null-loaded group,but relatively lower in the antagonist group,as compared with the sham operation group (P<0.05). The relative mRNA expression of tumor necrosis factor-α and interleukin-6 was also higher in the medial meniscus destabilization group and the null-loaded group compared with the antagonist group (P<0.05). To conclude,the expression level of microRNA-214 in articular cartilage was elevated in the mouse osteoarthritis model,suggesting that the elevated expression level of microRNA-214 is closely related to osteoarthritis;and injection of microRNA-214 antagonist into the knee joint cavity of the mouse osteoarthritis model could delay articular cartilage degradation,promote subchondral bone remodeling,and ameliorate the progression of osteoarthritis.

Ossification of the posterior longitudinal ligament (OPLL) is a condition comprising ectopic bone formation from spinal ligaments. This disease is a leading cause of myelopathy in the Asian population. However, the molecular mechanism underlying OPLL and efficient preventive interventions remain unclear. Here, we performed single-cell RNA sequencing and revealed that type I interferon (IFN) signaling was activated in the ossified ligament of patients with OPLL. We also observed that IFN-β stimulation promoted the osteogenic differentiation of preosteoblasts in vitro and activated the ossification-related gene SPP1, thereby confirming the single-cell RNA sequencing findings. Further, blocking the IFN-α/β subunit 1 receptor (IFNAR1) using an anti-IFNAR1 neutralizing antibody markedly suppressed osteogenic differentiation. Together, these results demonstrated that the type I IFN signaling pathway facilitated ligament ossification, and the blockade of this signaling might provide a foundation for the prevention of OPLL.
Humans ; Signal Transduction ; Interferon Type I/metabolism* ; Ossification of Posterior Longitudinal Ligament/genetics* ; Gene Expression Profiling ; Single-Cell Analysis ; Osteogenesis/genetics* ; Receptor, Interferon alpha-beta/metabolism* ; Male ; Female ; Cell Differentiation ; Middle Aged

Objective:To develop a predictive model for intrapartum fever related to chorioamnionitis in parturients undergoing epidural labor analgesia.Methods:This was a retrospective study. The parturients with intrapartum fever (axillary temperature ≥38 ℃) who received epidural labor analgesia from January 2020 to December 2022 in Sichuan Maternal and Child Health Hospital were selected as model group, and parturients with intrapartum fever who received epidural labor analgesia from January to October 2023 in Sichuan Maternal and Child Health Hospital were selected as validation group. The parturients in model group were divided into histological chorioamnionitis stage ≥Ⅱ group (HCA≥Ⅱ group) and histological chorioamnionitis stage <Ⅱ group (HCA<Ⅱ group) according to the results of placental histopathological examination. Logistic regression analysis was used to screen the independent risk factors for intrapartum fever related to chorioamnionitis in parturients, and then a nomogram model was established. The discrimination of the model was verified by the area under the the receiver operating characteristic curve. The consistency of the model was verified by the calibration curve, and the clinical effectiveness of the model was determined by the decision curve. The validation dataset was used to further evaluate the model.Results:A total of 308 parturients were finally included in model group and 99 parturients in validation group. Multivariate logistic regression analysis showed that the gestational age, meconium-stained amniotic fluid, c-reactive protein concentration and maximum body temperature were independent risk factors for intrapartum fever related to chorioamnionitis in parturients undergoing epidural labor analgesia ( P<0.05). Based on this, a nomogram risk prediction model was developed. The area under the curve (95% confidence interval) was 0.844 (0.744-0.944) in model group and 0.812 (0.674-0.950) in validation group. The calibration curve showed that the prediction probability of the model had good consistency with the actual probability of diagnosis. The decision curve showed that the threshold probability of the prediction model in model group and validation group was 10%-98% and 10%-78%, respectively. Conclusions:A nomogram prediction model for intrapartum fever related to chorioamnionitis is successfully established based on the gestational age, c-reactive protein concentration, meconium-stained amniotic fluid and maximum body temperature in parturients undergoing epidural labor analgesia. The model has good predictive performance and clinical value.

Objective To compare the efficacy of anterior-posterior and posterior-anterior screw fixation for posterior malleolar fractures surgery.Methods A retrospective analysis of 376 cases of posterior malleolar fractures treated with lag screws from January 2011 to October 2022 with more than 12 months of follow-up period was conducted.The patients were divided into two subgroups based on the thickness of the fracture fragment,with 167 cases in the small fracture subgroup having a fracture fragment thickness＜17 mm(screw thread length)and 209 cases in the large fracture subgroup having a fracture fragment thickness ≥ 17 mm.Each subgroup was further divided into anterior-posterior and posterior-anterior groups based on the direction of screw fixation in the posterior malleolar fracture surgery.In the small fracture subgroups,there were 74 cases in the anterior-posterior group and 93 cases in the posterior-anterior group.In the large fracture subgroup,there were 88 cases in the anterior-posterior group and 121 cases in the posterior-anterior group.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was measured at the last follow-up.The displacement of the fracture fragment in the direction of the fracture line(Dn)and perpendicular to the fracture line(Dt)were measured on the first day after surgery and at the last follow-up,and the displacement of the fracture fragment was calculated,which was the difference between Dn+Dt at the last follow-up and Dn+Dt on the first day after surgery.Results On the first day after surgery,X-ray showed no significant difference in Dn and Dt between the anterior-posterior and posterior-anterior groups in both of the small and large fracture subgroups(P＞0.05).The entire group was followed up for 12-85 months,with an average of 19.3 months.In the small fracture subgroup,the displacement of the fracture fragment in the posterior-anterior group[(0.11±0.19)mm]was superior to that in the anterior-posterior group[(0.19±0.21)mm;P=0.011],and the AOFAS score was also superior to that in the anterior-posterior group[(80.2±8.4)points vs.(76.2±8.6)points,P=0.003].In the large fracture subgroup,there was no significant difference in fracture displacement between the posterior-anterior group[(0.11±0.18)mm]and the anterior-posterior group[(0.12±0.19)mm;P=0.630],and there was also no significant difference in AOFAS scores[(84.1±7.8)points vs.(82.8±7.6)points,P=0.246].Conclusions There is no significant difference in the reduction effect between anterior-posterior and posterior-anterior lag screw internal fixation for posterior malleolar fractures in trimalleolar fractures.For patients with fracture thickness＜17 mm,posterior-anterior fixation is superior to anterior-posterior fixation;for patients with fracture thickness ≥17 mm,there is no significant difference in the efficacy between anterior-posterior and posterior-anterior fixation.

Objective:To investigate the application effect of 3D digital modeling combined with 3D printed model in assisting the classroom theoretical teaching of orthopedics in five-year undergraduate students majoring in clinical medicine.Methods:In May 2022, 33 five-year undergraduate students majoring in clinical medicine in the class of 2018 in Southwest Medical University were selected and divided into experimental group with 17 students and control group with 16 students according to the odd or even student number. The students in the experimental group were taught by traditional PPT+3D digital modeling combined with 3D printed model, and those in the control group were taught by the traditional PPT teaching method. The teaching effect was evaluated by theoretical examination and a questionnaire survey on the degree of satisfaction with teaching. SPSS 25.0 was used to perform the t-test, the Mann-Whitney U test, the rank sum test, and the chi-square test. Results:The experimental group had a significantly higher score of theoretical examination than the control group (86.24±4.16 vs. 82.50±6.06). The questionnaire survey on the degree of satisfaction with teaching showed that compared with the control group, the experimental group had a significantly higher degree of satisfaction with the understanding and learning of orthopedic diseases [3 (2, 3) vs. 2 (2, 2), P < 0.05], the improvement in learning interest [2 (2, 3) vs. 2 (1, 2), P < 0.05], classroom innovation [3 (3, 3) vs. 2 (1.5, 2), P < 0.05], and overall classroom teaching [3 (2, 3) vs. 2 (2, 2), P < 0.05]. Conclusion:In assisting the classroom theoretical teaching of orthopedics in undergraduate students majoring in clinical medicine, 3D digital modeling combined with 3D printed model can provide concrete 3D models, reduce the difficulties in learning, improve the awareness of orthopedic diseases, strengthen learning interest, and increase the degree of satisfaction with teaching and academic scores.