ObjectiveTo explore the complex network relationships among pain, kinesiophobia, social participation and knee function in patients after total knee arthroplasty (TKA), and to analyze the moderating effects of different socio-structural factors on the rehabilitation network from an ethical equity perspective. MethodsA convenience sampling method was used to select 291 patients who underwent TKA in Qilu Hospital of Shandong University from May to July, 2023. Pain was assessed using Numerical Rating Scale, kinesiophobia with Chinese short version of the Tampa Scale for Kinesiophobia, social participation with Impact on Participation and Autonomy Questionnaire, and knee function with Hospital for Special Surgery Knee Score. A partial correlation network among pain, kinesiophobia, social participation and knee function was constructed using Graphical Least Absolute Shrinkage and Selection Operator. Key variables were identified through node centrality and bridge centrality analysis. Network Comparison Tests (NCT) were used to analyze network differences among subgroups based on different socio-structural characteristics. ResultsIn the network model, the nodes with the highest strength centrality were indoor participation, activity behavior and activity pain. Bridge centrality analysis indicated that activity pain, knee function, indoor participation and activity cognition were key bridge nodes. NCT revealed no significant differences in overall network structure or global strength among subgroups based on residence, education level or payment method (P > 0.05). However, significant differences in edge weights were found for specific edges such as activity cognition-activity behavior and knee function-indoor participation (P < 0.05). ConclusionThere is a network of interactions among pain, kinesiophobia, social participation and knee function in patients after TKA, with nodes such as indoor participation and activity pain playing key roles in the rehabilitation process. Although the overall rehabilitation network is similar across different socio-structural groups, variations exist in specific relational pathways among patients from rural areas, those with lower education levels, and those with out-of-pocket payment. This suggests that clinical rehabilitation interventions should focus on these core nodes and implement targeted support strategies for socio-structurally disadvantaged groups to promote rehabilitation equity.

ObjectiveTo explore the complex network relationships among pain, kinesiophobia, social participation and knee function in patients after total knee arthroplasty (TKA), and to analyze the moderating effects of different socio-structural factors on the rehabilitation network from an ethical equity perspective. MethodsA convenience sampling method was used to select 291 patients who underwent TKA in Qilu Hospital of Shandong University from May to July, 2023. Pain was assessed using Numerical Rating Scale, kinesiophobia with Chinese short version of the Tampa Scale for Kinesiophobia, social participation with Impact on Participation and Autonomy Questionnaire, and knee function with Hospital for Special Surgery Knee Score. A partial correlation network among pain, kinesiophobia, social participation and knee function was constructed using Graphical Least Absolute Shrinkage and Selection Operator. Key variables were identified through node centrality and bridge centrality analysis. Network Comparison Tests (NCT) were used to analyze network differences among subgroups based on different socio-structural characteristics. ResultsIn the network model, the nodes with the highest strength centrality were indoor participation, activity behavior and activity pain. Bridge centrality analysis indicated that activity pain, knee function, indoor participation and activity cognition were key bridge nodes. NCT revealed no significant differences in overall network structure or global strength among subgroups based on residence, education level or payment method (P > 0.05). However, significant differences in edge weights were found for specific edges such as activity cognition-activity behavior and knee function-indoor participation (P < 0.05). ConclusionThere is a network of interactions among pain, kinesiophobia, social participation and knee function in patients after TKA, with nodes such as indoor participation and activity pain playing key roles in the rehabilitation process. Although the overall rehabilitation network is similar across different socio-structural groups, variations exist in specific relational pathways among patients from rural areas, those with lower education levels, and those with out-of-pocket payment. This suggests that clinical rehabilitation interventions should focus on these core nodes and implement targeted support strategies for socio-structurally disadvantaged groups to promote rehabilitation equity.

ObjectiveTo explore the complex network relationships among pain, kinesiophobia, social participation and knee function in patients after total knee arthroplasty (TKA), and to analyze the moderating effects of different socio-structural factors on the rehabilitation network from an ethical equity perspective. MethodsA convenience sampling method was used to select 291 patients who underwent TKA in Qilu Hospital of Shandong University from May to July, 2023. Pain was assessed using Numerical Rating Scale, kinesiophobia with Chinese short version of the Tampa Scale for Kinesiophobia, social participation with Impact on Participation and Autonomy Questionnaire, and knee function with Hospital for Special Surgery Knee Score. A partial correlation network among pain, kinesiophobia, social participation and knee function was constructed using Graphical Least Absolute Shrinkage and Selection Operator. Key variables were identified through node centrality and bridge centrality analysis. Network Comparison Tests (NCT) were used to analyze network differences among subgroups based on different socio-structural characteristics. ResultsIn the network model, the nodes with the highest strength centrality were indoor participation, activity behavior and activity pain. Bridge centrality analysis indicated that activity pain, knee function, indoor participation and activity cognition were key bridge nodes. NCT revealed no significant differences in overall network structure or global strength among subgroups based on residence, education level or payment method (P > 0.05). However, significant differences in edge weights were found for specific edges such as activity cognition-activity behavior and knee function-indoor participation (P < 0.05). ConclusionThere is a network of interactions among pain, kinesiophobia, social participation and knee function in patients after TKA, with nodes such as indoor participation and activity pain playing key roles in the rehabilitation process. Although the overall rehabilitation network is similar across different socio-structural groups, variations exist in specific relational pathways among patients from rural areas, those with lower education levels, and those with out-of-pocket payment. This suggests that clinical rehabilitation interventions should focus on these core nodes and implement targeted support strategies for socio-structurally disadvantaged groups to promote rehabilitation equity.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To investigate the factors affecting the efficacy of 131I treatment for Graves′ disease (GD) and to construct a predictive model for the treatment outcomes of 131I therapy. Methods:Retrospective analysis of the treatment efficacy was performed on 2 190 patients (547 males, 1 643 females, age (42.9±12.4) years) with GD, who received initial 131I treatment in Tianjin Medical University General Hospital between October 2013 and May 2018. Univariate analysis ( χ2 test, et al) and logistic regression were performed to analyze the possible factors affecting the efficacy of 131I treatment. An efficacy prediction model for 131I treatment of GD was constructed, and decision curve analysis (DCA) was used to evaluate the clinical utility of the prediction model. Results:The overall effectiveness rate of 131I treatment for GD patients was 99.95%(2 189/2 190), with a total cure rate of 83.74%(1 834/2 190), among which 94.11%(1 726/1 834) were cured after a single treatment. Pre-treatment thyroid mass was identified as an independent risk factor affecting the efficacy of initial 131I treatment (odds ratio ( OR)=0.983(95% CI: 0.977-0.989), P<0.001). The clinical cure rate was higher in patients who received an adequate dose of 131I compared with that in patients who didn′t receive an adequate dose (79.97%(1 537/1 922) vs 70.52%(189/268); χ2=12.57, P<0.001), but it did not increase the incidence of hypothyroidism within one year. A predictive model was constructed, and it was found that thyroid mass and disease duration had a relatively high impact on the clinical cure rate. The concordance index (C-index) of the predictive model was 0.623(95% CI: 0.593-0.654). DCA indicated that the predictive model offered substantial net benefits across a wide range of probability thresholds. Conclusions:131I treatment is effective in most patients with GD. The predictive model for efficacy of initial 131I treatment developed in this study can assist in evaluating treatment outcomes and help clinicians select the most suitable 131I treatment dose, enhancing clinical decision-making.

Objective To explore the therapeutic mechanism of hot compress with Sangzhi Shengjiang Decoction(manily composed of Zingiberis Rhizoma Recens,Mori Ramulus,Cinnamomi Ramulus,Speranskiae Tuberculatae Herba,and Cervi Cornus Colla)in relieving pain and improving hemorheology of patients with femoral head necrosis(FHN).Methods A total of 104 patients with FHN who admitted to Guang'anmen Hospital Baoding,China Academy of Chinese Medical Sciences from May 2022 to May 2024 were randomly divided into the control group and the treatment group according to the random number table method,with 52 cases in each group.The control group was treated with Alendronate Sodium orally,and the treatment group was given hot compress with Sangzhi Shengjiang Decoction on the basis of treatment for the control group.The course of treatment for the two groups covered three months.Before and after the treatment,the traditional Chinese medicine(TCM)syndrome score,Harris score of joint function,Visual Analogue Scale(VAS)score for pain,and the levels of hemorheology indicators,bone metabolism indicators,and bone mineral density(BMD)of proximal femur and lumbar trabecular bone in the two groups were observed.After treatment,the clinical efficacy of patients in the two groups was evaluated.Results(1)After three months of treatment,the total effective rate of the treatment group was 92.31％(48/52)and that of the control group was 71.15％(37/52),and the intergroup comparison(tested by chi-square test)showed that the clinical efficacy of the treatment group was significantly superior to that of the control group(P<0.01).(2)After treatment,the scores of TCM symptoms such as soreness and weakness in the waist and knee,claudication,restlessness and insomnia,and soreness and heaviness of lower limbs in the two groups were decreased compared with those before treatment(P<0.05),and the decreases in the treatment group were significantly superior to that in the control group(P<0.01).(3)After treatment,the Harris scores of joint function in the two groups were increased(P<0.05)and the VAS scores for pain were decreased compared with those before treatment(P<0.05),and the increase of Harris scores and the decrease of VAS scores in the treatment group were significantly superior to those in the control group(P<0.01).(4)After treatment,the levels of hemorheology indicators such as erythrocyte sedimentation rate(ESR),whole blood low-shear viscosity(LBV),and whole blood high-shear viscosity(HBV)in the two groups were improved compared with those before treatment(P<0.05),and the improvement in the treatment group was significantly superior to that in the control group(P<0.01).(5)After treatment,the levels of bone metabolism indicators such as serum N-terminal mid-fragment of osteocalcin(N-MID)β-C-terminal telopeptide of type Ⅰ collagen(β-CTX)and total procollagen type Ⅰ N-terminal propeptide(T-PINP)levels of patients in the two groups were decreased compared with those before treatment(P<0.05),and serum 25-hydroxy vitamin D[25-(OH)D]level was increased compared with that before treatment(P<0.05).The decrease of serum N-MID,β-CTX and T-PINP levels and the increase of serum 25-(OH)D level in the treatment group were significantly superior to those in the control group(P<0.01).(6)After treatment,BMD of proximal femur and lumbar trabecular bone in the two groups was increased compared with that before treatment(P<0.05),and the increase in the treatment group was significantly superior to that in the control group(P<0.01).Conclusion Hot compress with Sangzhi Shengjiang Decoction exerts certain efficacy for the treatment of patients with FHN.The therapy is effective on reducing the scores of TCM syndrome,relieving pain,improving joint function,regulating bone metabolism and bone density,improving hemorheology indicators,and presenting remarkable therapeutic effect.

Objective To explore the mechanism of Taohong Siwu Decoction in recovering joint muscle strength and bone mineral density(BMD)in patients after hip preservation surgery for osteonecrosis of the femoral head(ONFH).Methods A total of 110 ONFH patients admitted to Guang'anmen Hospital Baoding Branch,China Academy of Chinese Medical Sciences from April 2022 to April 2024 were enrolled.The patients were equally randomized into a control group and a study group using a random number table,with 55 cases in each group.All patients underwent core decompression surgery and then were given postoperative conventional western medical treatment,and the study group received additional modified Taohong Siwu Decoction.The course of treatment lasted for 8 weeks.Before and after treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,Visual Analogue Scale(VAS)score for pain,Harris hip score,joint muscle strength,bone mineral density(BMD),hemorheological parameters(including plasma viscosity,whole blood high-shear viscosity,and whole blood low-shear viscosity),and bone metabolism markers[including alkaline phosphatase(ALP),osteocalcin(BGP),and bone morphogenetic protein 2(BMP-2)].After treatment,the clinical efficacy was evaluated between groups.Results(1)After 8 weeks of treatment,the total effective rate in the study group was 92.73%(51/55),which was significantly higher than that in the control group(72.73%,40/55).The intergroup comparison showed a statistically significant difference(χ2=7.698,P＜0.01).(2)After treatment,scores for hip pain,soreness and weakness of the lower back and knees,mental fatigue,and deep-thin-choppy pulse decreased in both groups compared with those before treatment(P＜0.05).Moreover,the magnitude of reduction in all these scores was significantly greater in the study group than that in the control group(P＜0.01).(3)After treatment,the VAS scores for pain severity decreased in both groups compared with baseline(P＜0.05),while the Harris scores for joint function increased in both groups(P＜0.05).Furthermore,the magnitude of reduction in VAS scores and the magnitude of improvement in Harris scores were both significantly greater in the study group than those in the control group(P＜0.01).(4)After treatment,plasma viscosity,high-shear whole blood viscosity,and low-shear whole blood viscosity decreased in both groups compared with those before treatment(P＜0.05).Additionally,the reductions in all these parameters were significantly more pronounced in the study group than in the control group(P＜0.01).(5)After treatment,serum alkaline phosphatase(ALP)levels decreased in both groups(P＜0.05),while serum osteocalcin(BGP)and bone morphogenetic protein-2(BMP-2)levels increased in both groups(P＜0.05).Crucially,the magnitude of reduction in serum ALP levels and the magnitude of elevation in serum BGP and BMP-2 levels were all significantly greater in the study group than those in the control group(P＜0.01).(6)After treatment,in the study group,the number of patients with Grade 3 muscle strength significantly decreased while the number with Grade 4 muscle strength significantly increased compared with those before treatment(P＜0.05).In contrast,although the control group showed some improvement in joint muscle strength,the changes were not statistically significant(P＞0.05).After treatment,the intergroup comparisons showed that the study group had a significantly smaller number of patients with Grade 3 muscle strength and a significantly larger number with Grade 4 muscle strength than the control group(P＜0.01).(7)After treatment,both local femoral head BMD and average BMD increased in both groups compared with those before treatment(P＜0.05).The magnitude of increase in both local and average BMD was significantly greater in the study group than that in the control group(P＜0.01).Conclusion The application of Taohong Siwu Decoction in the treatment of in patients after hip preservation surgery for ONFH is effective on reducing TCM syndrome scores,alleviating pain,improving joint function and hemorheology,and restoring BMD and bone metabolism indicators,which enhances the overall clinical efficacy for the patients.

Objective To explore the effectiveness of the peripheral arterial calcification scoring system(PACSS)based on computed tomography angiography(CTA)in assessing renal function in patients with peripheral arterial disease(PAD).Methods The clinical data,CTA imaging data,and laboratory results from PAD patients who underwent lower limb artery CTA examination were retrospectively collected.The PACSS was utilized to score the calcification in both lower limb arteries.Participants were categorized into three groups based on their estimated glomerular filtration rate(eGFR)(normal group:eGFR≥90 mL/min;mild renal dysfunction group:eGFR 60-89 mL/min,and moderate to severe renal dysfunction group:eGFR＜60 mL/min).The demographic data,clinical symptoms,and comorbidities among the three groups were compared by analysis of variance(ANOVA).The Spearman correlation coefficient was employed to evaluate the relationship between eGFR,cystatin C,and PACSS score.Results The age(P＜0.001)and PACSS score(P＜0.05)of patients with renal dysfunction were significantly higher than those of patients with normal renal function.However,there were no significant differences in gender,prevalence of diabetes,hypertension,or severe limb ischemia.Spearman correlation analysis showed that eGFR was negatively correlated with PACSS score(r=-0.18 in the right lower limb,P=0.037,r=-0.24 in the left lower limb,P=0.006).In contrast,cystatin C was positively correlated with PACSS score(r=0.26 in the right lower limb,P＜0.001,r=0.22 in the left lower limb,P=0.002).Conclusion The PACSS score of lower limb artery in PAD patients is corre-lated with the severity of renal dysfunction.This finding may facilitate early warning and clinical intervention for PAD patients with renal dysfunction.

Aim To investigate the protective effect of Vaccarin(Va)on epithelial-mesenchymal transition(EMT)in renal fibrosis model mice through regulating STAT3,and the underlying mechanism.Methods Left ureter ligation was used to establish a mouse model of unilateral ureteral obstruction(UUO);human kid-ney tubular epithelial(HK2)cells were induced to differentiate by transforming growth factor-β(TGF-β)in vitro.HE and Masson staining were used to observe the morphological changes of renal tissue;kits were used to detect the levels of BUN,Cr,IL-1β and IL-7 in mouse serum;CCK-8 was used to detect the effect of Va on the viability of HK2 cells;RT-PCR was used to detect the levels of inflammatory factors in HK2 cells;Western blot was used to detect the expression of STAT3,p-STAT3,E-cadherin,and α-SMA proteins in renal tissue and HK2 cells;to further investigate the regulation of Va on STAT3,JAK/STAT3 pathway acti-vator RO8191 was used to treat TGF-β-induced HK2 cells,and functional loss was detected.Results Va improved the pathological damage in UUO mice,inhibi-ted the levels of BUN,Cr and inflammatory factors;Va inhibited the phosphorylation of STAT3,upregulated E-cadherin,and downregulated α-SMA protein expres-sion;RO8191 counteracted the inhibitory effect of Va on the phosphorylation of STAT3.Conclusions Va inhibits the phosphorylation of STAT3 and the release of inflammatory factors,improves EMT,thus exerting an anti-renal fibrosis effect.