Objective To investigate the isokinetic muscle strength,balance ability and gait characteristics in patients with ankle fractures,providing references for the formulation of rehabilita-tion plans and the establishment of efficacy evaluation criteria.Methods Thirty-six patients with an-kle fracture were selected as experimental group,while 20 healthy individuals were recruited as con-trol group.The isokinetic muscle strength of the ankle and hip joints,balance ability,and gait char-acteristics of the two groups were measured and compared.Results At angular velocities of 60°/s and 120°/s,the relative peak torque of isokinetic muscle strength for hip abduction and extension in the experimental group was significantly lower than that in the control group(P＜0.05).Similarly,the relative peak torque of isokinetic muscle strength for ankle plantarflexion and dorsiflexion in the experimental group was also significantly lower than those in the control group(P＜0.05).The bal-ance instrument measurement indicators(length of center of gravity sway trajectory,peripheral area of center of gravity sway)in the experimental group were significantly greater than those in the control group(P＜0.05).The Tinetti Performance-Oriented Mobility Assessment(POMA)score in the ex-perimental group was significantly lower than that in the control group(P＜0.05).According to the Tinetti POMA scoring criteria,the proportion of individuals at risk of falling(Tinetti POMA score＜24)in the experimental group was significantly higher than that in the control group(P＜0.05).The range of motion of the affected hip joint,stride length,and walking speed during the gait cycle in the experimental group were significantly smaller than those in the control group,while the gait cycle duration was significantly longer(P＜0.05).Conclusion After a certain period of rehabilitation,there is a certain gap in the isokinetic muscle strength of the ankle and hip joints,balance ability,and gait function between patients with ankle fractures and healthy individuals.Our findings in the study are of great significance for the subsequent formulation of rehabilitation plans and efficacy evaluation.

Objective:To investigate the value of transanal multipoint full-layer puncture biopsy (TMFP) in predicting pathological complete response (pCR) after neoadjuvant radiotherapy and chemotherapy (nCRT) in patients with locally advanced rectal cancer (LARC) and to establish a predictive model for providing clinical guidance regarding the treatment of LARC.Methods:In this multicenter, prospective, cohort study, we collected data on 110 LARC patients from four hospitals between April 2020 and March 2023: Beijing Chaoyang Hospital of Capital Medical University (50 patients), Beijing Friendship Hospital of Capital Medical University (41 patients), Qilu Hospital of Shandong University (16 patients), and Zhongnan Hospital of Wuhan University (three patients). The patients had all received TMFP after completing standard nCRT. The variables studied included (1) clinicopathological characteristics; (2) clinical complete remission (cCR) and efficacy of TMFP in determining pCR after NCRT in LARC patients; and (3) hospital attended, sex, age, clinical T- and N-stages, distance between the lower margin of the tumor and the anal verge, baseline and post-radiotherapy serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 concentrations, chemotherapy regimen, use of immunosuppressants with or without radiotherapy, radiation therapy dosage, interval between surgery and radiotherapy, surgical procedure, clinical T/N stage after radiotherapy, cCR, pathological results of TMFP, puncture method (endoscopic or percutaneous), and number and timing of punctures. Single-factor and multifactorial logistic regression analysis were used to determine the factors affecting pCR after NCRT in LARC patients. A prediction model was constructed based on the results of multivariat analysis and the performance of this model evaluated by analyzing subject work characteristics (ROC), calibration, and clinical decision-making (DCA) curves. pCR was defined as complete absence of tumor cells on microscopic examination of the surgical specimens of rectal cancer (including lymph node dissection) after NCRT, that is, ypT0+N0. cCR was defined according to the Chinese Neoadjuvant Rectal Cancer Waiting Watch Database Study Collaborative Group criteria after treatment, which specify an absence of ulceration and nodules on endoscopy; negative rectal palpation; no tumor signals on rectal MRI T2 and DWI sequences; normal serum CEA concentrations, and no evidence of recurrence on pelvic computed tomography/magnetic resonance imaging.Results:Of the 110 patients, 45 (40.9%) achieved pCR after nCRT, which was combined with immune checkpoint inhibitors in 34 (30.9%). cCR was diagnosed before puncture in 38 (34.5%) patients, 43 (39.1%) of the punctures being endoscopic. There were no complications of puncture such as enterocutaneous fistulae, vaginal injury, prostatic injury, or presacral bleeding . Only one (2.3%) patient had a small amount of blood in the stools, which was relieved by anal pressure. cCR had a sensitivity of 57.8% (26/45) for determining pCR, specificity of 81.5% (53/65), accuracy of 71.8% (79/110), positive predictive value 68.4% (26/38), and negative predictive value of 73.6% (53/72). In contrast, the sensitivity of TMFP pathology in determining pCR was 100% (45/45), specificity 66.2% (43/65), accuracy 80.0% (88/110), positive predictive value 67.2% (45/67), and negative predictive value 100.0% (43/43). In this study, the sensitivity of TMFP for pCR (100.0% vs. 57.8%, χ 2=24.09, P<0.001) was significantly higher than that for cCR. However, the accuracy of pCR did not differ significantly (80.0% vs. 71.8%, χ 2=2.01, P=0.156). Univariate and multivariate logistic regression analyses showed that a ≥4 cm distance between the lower edge of the tumor and the anal verge (OR=7.84, 95%CI: 1.48-41.45, P=0.015), non-cCR (OR=4.81, 95%CI: 1.39-16.69, P=0.013), and pathological diagnosis by TMFP (OR=114.29, the 95%CI: 11.07-1180.28, P<0.001) were risk factors for pCR after NCRT in LARC patients. Additionally, endoscopic puncture (OR=0.02, 95%CI: 0.05-0.77, P=0.020) was a protective factor for pCR after NCRT in LARC patients. The area under the ROC curve of the established prediction model was 0.934 (95%CI: 0.892-0.977), suggesting that the model has good discrimination. The calibration curve was relatively close to the ideal 45° reference line, indicating that the predicted values of the model were in good agreement with the actual values. A decision-making curve showed that the model had a good net clinical benefit. Conclusion:Our predictive model, which incorporates TMFP, has considerable accuracy in predicting pCR after nCRT in patients with locally advanced rectal cancer. This may provide a basis for more precisely selecting individualized therapy.

Objective:To investigate the value of transanal multipoint full-layer puncture biopsy (TMFP) in predicting pathological complete response (pCR) after neoadjuvant radiotherapy and chemotherapy (nCRT) in patients with locally advanced rectal cancer (LARC) and to establish a predictive model for providing clinical guidance regarding the treatment of LARC.Methods:In this multicenter, prospective, cohort study, we collected data on 110 LARC patients from four hospitals between April 2020 and March 2023: Beijing Chaoyang Hospital of Capital Medical University (50 patients), Beijing Friendship Hospital of Capital Medical University (41 patients), Qilu Hospital of Shandong University (16 patients), and Zhongnan Hospital of Wuhan University (three patients). The patients had all received TMFP after completing standard nCRT. The variables studied included (1) clinicopathological characteristics; (2) clinical complete remission (cCR) and efficacy of TMFP in determining pCR after NCRT in LARC patients; and (3) hospital attended, sex, age, clinical T- and N-stages, distance between the lower margin of the tumor and the anal verge, baseline and post-radiotherapy serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 concentrations, chemotherapy regimen, use of immunosuppressants with or without radiotherapy, radiation therapy dosage, interval between surgery and radiotherapy, surgical procedure, clinical T/N stage after radiotherapy, cCR, pathological results of TMFP, puncture method (endoscopic or percutaneous), and number and timing of punctures. Single-factor and multifactorial logistic regression analysis were used to determine the factors affecting pCR after NCRT in LARC patients. A prediction model was constructed based on the results of multivariat analysis and the performance of this model evaluated by analyzing subject work characteristics (ROC), calibration, and clinical decision-making (DCA) curves. pCR was defined as complete absence of tumor cells on microscopic examination of the surgical specimens of rectal cancer (including lymph node dissection) after NCRT, that is, ypT0+N0. cCR was defined according to the Chinese Neoadjuvant Rectal Cancer Waiting Watch Database Study Collaborative Group criteria after treatment, which specify an absence of ulceration and nodules on endoscopy; negative rectal palpation; no tumor signals on rectal MRI T2 and DWI sequences; normal serum CEA concentrations, and no evidence of recurrence on pelvic computed tomography/magnetic resonance imaging.Results:Of the 110 patients, 45 (40.9%) achieved pCR after nCRT, which was combined with immune checkpoint inhibitors in 34 (30.9%). cCR was diagnosed before puncture in 38 (34.5%) patients, 43 (39.1%) of the punctures being endoscopic. There were no complications of puncture such as enterocutaneous fistulae, vaginal injury, prostatic injury, or presacral bleeding . Only one (2.3%) patient had a small amount of blood in the stools, which was relieved by anal pressure. cCR had a sensitivity of 57.8% (26/45) for determining pCR, specificity of 81.5% (53/65), accuracy of 71.8% (79/110), positive predictive value 68.4% (26/38), and negative predictive value of 73.6% (53/72). In contrast, the sensitivity of TMFP pathology in determining pCR was 100% (45/45), specificity 66.2% (43/65), accuracy 80.0% (88/110), positive predictive value 67.2% (45/67), and negative predictive value 100.0% (43/43). In this study, the sensitivity of TMFP for pCR (100.0% vs. 57.8%, χ 2=24.09, P<0.001) was significantly higher than that for cCR. However, the accuracy of pCR did not differ significantly (80.0% vs. 71.8%, χ 2=2.01, P=0.156). Univariate and multivariate logistic regression analyses showed that a ≥4 cm distance between the lower edge of the tumor and the anal verge (OR=7.84, 95%CI: 1.48-41.45, P=0.015), non-cCR (OR=4.81, 95%CI: 1.39-16.69, P=0.013), and pathological diagnosis by TMFP (OR=114.29, the 95%CI: 11.07-1180.28, P<0.001) were risk factors for pCR after NCRT in LARC patients. Additionally, endoscopic puncture (OR=0.02, 95%CI: 0.05-0.77, P=0.020) was a protective factor for pCR after NCRT in LARC patients. The area under the ROC curve of the established prediction model was 0.934 (95%CI: 0.892-0.977), suggesting that the model has good discrimination. The calibration curve was relatively close to the ideal 45° reference line, indicating that the predicted values of the model were in good agreement with the actual values. A decision-making curve showed that the model had a good net clinical benefit. Conclusion:Our predictive model, which incorporates TMFP, has considerable accuracy in predicting pCR after nCRT in patients with locally advanced rectal cancer. This may provide a basis for more precisely selecting individualized therapy.

Objective:To evaluate cardiopulmonary exercise fitness in patients with type 2 diabetes mellitus(T2DM)and investigate its influencing factors and possible mechanism. Method:A retrospective analysis was conducted on the medical records of 169 patients with T2DM who under-went cardiopulmonary exercise testing(CPET)from January 2021 to December 2022.Cardiopulmonary fitness was evaluated by peak oxygen consumption(peak VO2)value in CPET.Patients were divided into cardiopulmo-nary fitness normal group and abnormal group according to peak VO2％value in CPET.Univariate analysis was used to compare the differences in clinical data between the two groups,and multivariate Logistic regres-sion analysis was used to screen the independent influencing factors to construct risk prediction. Result:A total of 169 cases were included,with 48 cases in the cardiopulmonary fitness normal group and 121 cases in the abnormal group.Multivariate Logistic regression analysis showed that body mass index,histo-ry of hypertension,history of heart disease,glycated hemoglobin level,insulin resistance index and physical ex-ercise were independent influencing factors for the exercise fitness in T2DM(OR=1.278,5.159,3.876,2.911,2.586,0.086,all P＜0.05). Conclusion:Cardiopulmonary fitness is commonly reduced in patients with T2DM.Body mass index,glycated hemoglobin level,insulin resistance index,history of hypertension,history of heart disease are independent risk factors for declined cardiopulmonary fitness.While regular physical exercise is a protective factor.

Objective:To evaluate the efficacy and safety of programmed death 1 (PD-1), programmed death ligand 1 (PD-L1) immune checkpoint inhibitor (ICI) monotherapy for brain metastasis in advanced non-small cell lung cancer (NSCLC), and to explore the timing of immunomonotherapy and the application of hormone on the efficacy of ICI.Methods:By searching literature in CNKI, Wanfang, VIP, PubMed, CBM, Embase, Cochrane Library and Web of Science databases, the advanced NSCLC patients with brain metastasis who received ICI treatment were identified, including patients with symptomatic brain metastasis who had received hormone therapy or brain surgery or radiotherapy. Meta-analysis was performed on the collected data to evaluate the systemic objective response rate (sORR) and intracerebral tumor objective response rate (iORR), the iORR of whether ICI monotherapy was first-line therapy, and the iORR of whether hormone was used were evaluated, and the incidence of adverse reactions was evaluated.Results:Fifteen studies were finally included, with a total of 4 033 patients, including 917 patients with brain metastasis. The iORR of immunomonotherapy was 26% (95% CI 19%-34%) and the sORR was 28% (95% CI 18%-40%). The iORR of first-line immunomonotherapy was 49% (95% CI 39%-58%). The iORR of symptomatic patients with hormone therapy and asymptomatic patients without hormone therapy was 26% (95% CI 20%-33%) and 19% (95% CI 16%-22%), respectively. The overall incidence of grade 3-4 adverse reactions was 14% (95% CI 11%-17%). Conclusions:The efficacy of ICI monotherapy in the first-line treatment of PD-L1-positive NSCLC patients with brain metastasis is better than that in the subsequent line therapy, and the application of hormone does not affect the efficacy of ICI. ICI monotherapy in the treatment of advanced NSCLC patients with brain metastasis is safe.

Objective:To observe the effect of marine capsules on BALB/c human hepatocellular carcinoma cell line SMMC-7721 in vitro. Methods:Human hepatoma SMMC-7721 cell line was cultured in vitro to establish a hepatoma tumor model, and was random-ly divided into the model control group, 5-Fu group (25 mg·kg-1), marine capsules high dose group (90 mg·kg-1), marine cap-sules low dose group (45 mg·kg-1 ) and the blank control group with 10 mice in each and 14-day continuous administration. Blood was taken from the eyeball and serum was isolated. The tumor strains were picked, the wet weight was obtained, the inhibition rate was calculated, and the pathological changes of tumor tissues were observed after HE staining. Results: Compared with that in the model control group, the serum IL-2 content significantly increased in the marine capsules high and the low dose groups ( P<0. 01, P<0. 05). The in vitro growth of tumor (P<0. 001, P<0. 05) was inhibited with the inhibition rate of 41. 56% and 27. 78% respectively for the high dose group and the low dose group, and the effects of the high dose group had no significant differences with those of 5-Fu group (P>0. 05). The nuclear staining of tumor cells was lighter and the number of tumor cells decreased in the two marine capsules groups. Conclusion:Marine capsules have certain inhibitory effects on BALB/c human hepatocellular carcinoma cell line SMMC-7721 in vitro.

Objective To observe the clinical efficacy ofXiaozhikang Formula Granules for the treatment of nonalcoholic fatty liver disease.Methods Totally 90 patients with nonalcoholic fatty liver disease were randomly divided into control group and treatment group, 45 cases in each group. Patients in the control group were treated with conventional western treatment and oral metformin enteric-coated metformin hydrochloride, while patients in the treatment group were treated withXiaozhikang Formula Granules on the basis of conventional western treatment for 3 months. Blood lipid and insulin resistance in the two groups before and after treatment were observed, and the clinical efficacy between the two groups was compared.Results Clinical excellence (35.5%), total effective rate (84.5%) and TCM syndrome score (13.78 ± 3.6) after treatment of treatment group were better than those of control group (P<0.05). GPT, GOT, TG, and TC in both groups were lower after the treatment (P<0.05,P<0.01). There existed statistical significance in TC and TG between the two groups after treatment (P<0.05). There existed statistical significance in B ultrasound index between the two groups after treatment (P<0.05), and the treatment group was superior. FBG and HOMA-IR in both groups significantly decreased after treatment (P<0.05), and the FBG in the treatment group after treatment was better than control group (P<0.05).Conclusion The efficacy ofXiaozhikang Formula Granules in the treatment of nonalcoholic fatty liver disease is remarkable.

One hundred patients were diagnosed with coronary heart disease through dual-source CT coronary angiography (DSCTA) in our hospital,including 53 cases aged ≥60 y (elderly group) and 47 cases ＜60 y (middle-aged group).The curved-planar reconstruction (CPR),maximal intensity projection (MIP) and other post-processing reconstruction techniques were used to evaluate the indicators and differences of coronary stenosis ≥ 50％ ; the X-ray coronary angiography (CAG) findings were regarded as the gold standard.The evaluable rates of coronary arteries through DSCTA were 97.0％ and 98.6％ for two groups (P ＞0.05).The positive rate of coronary artery stenosis ≥ 50％ in elderly group was higher than that of middle-age group ( 12.6％ vs 9.0％ P ＜0.05 ).The rates of multi-vessel disease in elderly group (28.3％ ) was also significantly higher than that of middle-age group (6.4％,P ＜0.05 ).The sensitivity,specificity,positive predictive value and negative predictive value in evaluation of coronary artery stenosis ≥ 50％ for elderly patients were 92.3％,98.0％,88.0％ and 98.9％ respectively; those for middle-aged patients were 96.0％,99.0％,90.6％ and 99.6％ respectively ( P ＞0.05 ).DSCTA imaging provides an effective screening and evaluation method for coronary heart disease in elderly and middle-aged patients.

ObjectiveTo study the maternal diet on neonatal weight and gestational diabetes,placental function and the impact of it. Methods93 cases of maternal gestational diabetes admitted to hospital with informed consent according to odd and even numbers randomly divided to observation group(50 case) and control group(43 cases) ,all accept conventional treatment,including exercise,health education and drug,observation group plus with diet control,compare the two sets of maternal placental maturity,amniotic fluid situation and the situation of fetal weight. ResultsObservation group with normal weight was 38 cases(76.0％ ) ,low body weight was 9 cases( 18.0％ ) ,huge children was 3 cases(6.0％ ) ,control group was 27 cases( 62.8％ ) ,2 cases(4.7％ ), 14 cases( 32.6％ ) ,two groups of great children birth rate had no significant difference( x2 =9.210,P =0. 002) ;placental maturity between the two groups showed no significant differenee( x2 =1. 034,3. 353 and 0. 433,P =0. 307,0. 067and 0. 510). Observation group normal amniotic fluid was 42 cases(84.0％ ) ,oligohydranmios was 6 cases( 12.0％ ) ,polyhydramnios was 2 cases(4.0％ ) ,the control group was 28 cases(65.1％ ) ,3 cases(7.0％ ) ,12 cases(27.9％ ) ,normal amniotic fluid and polyhydranmnios were significant differences between the two groups ( x2 =4. 429,8. 548, P =0. 035,0. 003 ).ConclusionDiet can reduce fetal macrosomia and the incidence of oligohydramnios, and it could ensure the maternal and child safety.

ObjectiveTo observe the therapeutic effect of proprioception strengthening training on knee osteoarthritis.MethodsBased on clinical diagnostic criteria, 80 patients with knee osteoarthritis were randomly divided into a treatment group(41 cases) and a control group(39 cases). The patients in the treatment group were administered proprioception strengthening training, muscle strengthening exercise and treatment with sodium hyaluronate injection of knee joint, while the patients in the control group were administered muscle strengthening exercise and treatment with sodium hyaluronate injection of knee joint. Before and after the treatment, knee function were assessed with Lysholm Assessment Standard on knee function.ResultsThe patients in both groups scored significantly higher on Lysholm on knee function than the patients before the treatment (P<0.01). The patients in the treatment group are better than the patients in the control group(P<0.01).ConclusionProprioception strengthening training can improve the knee function and it is a valid method to treat knee osteoarthritis.