Duchenne muscular dystrophy (DMD) is an X-linked recessive genetic disorder caused by mutations in the dystrophin gene, classified as a rare congenital muscular disease. Its clinical features include progressive skeletal muscle weakness, often involving respiratory and cardiac muscles, and frequently associated with spinal deformities. This paper reports the diagnosis, perioperative management, and follow-up of a case of DMD with multisystem involvement and severe scoliosis, aiming to provide a reference for clinicians in the diagnosis and treatment of such diseases.

Objective:To construct a "local-systemic" dual-track prediction model integrating the resistance index (RI) score of bilateral sacroiliac joints and the systemic immune-inflammation index (SII), and to evaluate its predictive efficacy for the active stage of ankylosing spondylitis (AS).Methods:A total of 205 patients with ankylosing spondylitis (AS) from the Second Hospital of Lanzhou University between April 2022 and April 2025 were retrospectively enrolled and categorized into an active group ( n=113) and a remission group ( n=92). Hematological parameters and ultrasound data were collected. The resistance index (RI) of the synovial area in bilateral sacroiliac joints was measured by Doppler ultrasound and scored as follows: RI < 0.5: 3 points; RI 0.5~0.55: 2 points; RI > 0.55: 1 point; undetectable blood flow: 0 points. A total bilateral RI score (range 0 to 6) was calculated. The systemic immune-inflammation index (SII) was derived as (neutrophils× platelets)/lymphocytes. Normality was tested for all continuous variables; normally distributed data were compared using the t-test, while non-normally distributed data were analyzed with the Mann-Whitney U test. Categorical variables were compared using the χ2 test or analysis of variance.Variable selection was performed using Lasso regression, and a multivariate logistic regression model was developed to assess predictive performance. Results:The proportion of patients with a bilateral RI total score≥5 was significantly higher in the active group compared to the remission group (50 of 113, 44.3% vs 2 of 92, 2.2%, χ2=55.63, P<0.001). Multivariate logistic regression analysis, after adjustment for confounding variables, identified the SII [ OR(95% CI)=1.01(1.00, 1.01), P<0.001], bilateral RI total score [ OR(95% CI)=1.67(1.29, 2.26), P<0.001], erythrocyte sedimentation rate [ OR(95% CI)=1.19(1.11, 1.30), P<0.001], and mean corpuscular hemoglobin concentration [ OR(95% CI)=1.09(1.03, 1.17), P<0.001] as independent risk factors for active AS. Conversely, lymphocyte count [ OR(95% CI)=0.42(0.18, 0.92), P=0.030] and globulin [ OR(95% CI)=0.89(0.80, 0.99), P=0.040] were significantly associated with protective effects. The bilateral RI total score demonstrated the strongest predictive effect, with each 1-point increase associated with a 67% elevation in the risk of active disease. ROC curve analysis indicated that the area under the curve (AUC) for predicting whether AS is in the active disease phase was 0.94 for the combined model (SII+bilateral RI total score), compared with 0.93 for the SII-alone model and 0.92 for the bilateral RI total score-alone model, demonstrating superior predictive performance of the combined model (SII+bilateral RI total score). An online prediction tool has been developed based on the combined model. Conclusion:The dual-track prediction model, which integrates local joint hemodynamic characteristics and systemic immune-inflammatory status, facilitates a multidimensional assessment of the risk of active AS and provides an objective basis for early identification.

Objective:To construct a "local-systemic" dual-track prediction model integrating the resistance index (RI) score of bilateral sacroiliac joints and the systemic immune-inflammation index (SII), and to evaluate its predictive efficacy for the active stage of ankylosing spondylitis (AS).Methods:A total of 205 patients with ankylosing spondylitis (AS) from the Second Hospital of Lanzhou University between April 2022 and April 2025 were retrospectively enrolled and categorized into an active group ( n=113) and a remission group ( n=92). Hematological parameters and ultrasound data were collected. The resistance index (RI) of the synovial area in bilateral sacroiliac joints was measured by Doppler ultrasound and scored as follows: RI < 0.5: 3 points; RI 0.5~0.55: 2 points; RI > 0.55: 1 point; undetectable blood flow: 0 points. A total bilateral RI score (range 0 to 6) was calculated. The systemic immune-inflammation index (SII) was derived as (neutrophils× platelets)/lymphocytes. Normality was tested for all continuous variables; normally distributed data were compared using the t-test, while non-normally distributed data were analyzed with the Mann-Whitney U test. Categorical variables were compared using the χ2 test or analysis of variance.Variable selection was performed using Lasso regression, and a multivariate logistic regression model was developed to assess predictive performance. Results:The proportion of patients with a bilateral RI total score≥5 was significantly higher in the active group compared to the remission group (50 of 113, 44.3% vs 2 of 92, 2.2%, χ2=55.63, P<0.001). Multivariate logistic regression analysis, after adjustment for confounding variables, identified the SII [ OR(95% CI)=1.01(1.00, 1.01), P<0.001], bilateral RI total score [ OR(95% CI)=1.67(1.29, 2.26), P<0.001], erythrocyte sedimentation rate [ OR(95% CI)=1.19(1.11, 1.30), P<0.001], and mean corpuscular hemoglobin concentration [ OR(95% CI)=1.09(1.03, 1.17), P<0.001] as independent risk factors for active AS. Conversely, lymphocyte count [ OR(95% CI)=0.42(0.18, 0.92), P=0.030] and globulin [ OR(95% CI)=0.89(0.80, 0.99), P=0.040] were significantly associated with protective effects. The bilateral RI total score demonstrated the strongest predictive effect, with each 1-point increase associated with a 67% elevation in the risk of active disease. ROC curve analysis indicated that the area under the curve (AUC) for predicting whether AS is in the active disease phase was 0.94 for the combined model (SII+bilateral RI total score), compared with 0.93 for the SII-alone model and 0.92 for the bilateral RI total score-alone model, demonstrating superior predictive performance of the combined model (SII+bilateral RI total score). An online prediction tool has been developed based on the combined model. Conclusion:The dual-track prediction model, which integrates local joint hemodynamic characteristics and systemic immune-inflammatory status, facilitates a multidimensional assessment of the risk of active AS and provides an objective basis for early identification.

OBJECTIVE: To analyze the differences in the effects of different mechanical stimuli on cells, cytokines, and proteins in synovial fluid of osteoarthritis joints, and to elucidate the indirect mechanism by which mechanical signals remodel the synovial fluid microenvironment through tissue cells. METHODS: Systematically integrate recent literature, focusing on the regulatory effects of different mechanical stimuli on the physicochemical properties of synovial fluid. Analyze the dynamic process by which mechanical stimuli regulate secretory and metabolic activities through tissue cells, thereby altering the physicochemical properties of cytokines and proteins. RESULTS: Appropriate mechanical stimuli activate mechanical signals in chondrocytes, macrophages, and synovial cells, thereby influencing cellular metabolic activities, including inhibiting the release of pro-inflammatory factors and promoting the secretion of anti-inflammatory factors, and regulating the expression of matrix and inflammation-related proteins such as cartilage oligomeric matrix protein, peptidoglycan recognition protein 4, and matrix metalloproteinases. CONCLUSION Mechanical stimuli act on tissue cells, indirectly reshaping the synovial fluid microenvironment through metabolic activities, thereby regulating the pathological process of osteoarthritis.
Humans ; Osteoarthritis/physiopathology* ; Synovial Fluid/chemistry* ; Chondrocytes/metabolism* ; Cytokines/metabolism* ; Macrophages/metabolism* ; Stress, Mechanical ; Cartilage Oligomeric Matrix Protein/metabolism* ; Matrix Metalloproteinases/metabolism* ; Synovial Membrane/cytology*

OBJECTIVE: To review the application progress of customized steel plates in osteotomy and orthopedic treatment for knee osteoarthritis (KOA), and provide reference for orthopedic surgeons and researchers. METHODS: Extensive review of the literature on customized steel plates for osteotomies and knee-preserving surgeries for KOA, 2015-2025, with an overview of the principles of customized steel plate design, clinical applications, and future directions, describing their advantages and shortcomings. RESULTS: Customized steel plates have demonstrated many advantages in osteotomy and orthopedic treatment of KOA, which not only enhance surgical outcomes and optimize mechanical properties, but also reduce the incidence of postoperative complications. However, high cost, long manufacturing period, and selection of patient indications are still important factors restricting their use. CONCLUSION Customized steel plates show promising potential in treating KOA. Not only do they reduce surgical duration and enhance postoperative healing outcomes, but they also effectively lower the incidence of postoperative complications, thereby improving patients' quality of life.
Humans ; Osteoarthritis, Knee/surgery* ; Osteotomy/methods* ; Bone Plates ; Postoperative Complications/epidemiology* ; Steel ; Quality of Life ; Treatment Outcome ; Knee Joint/surgery*

BACKGROUND: Premature menopause, defined as natural menopause before age 40, is associated with diminished ovarian reserve. Despite growing concerns regarding environmental pollutants, no large-scale population-based studies have systematically examined the association between urinary polycyclic aromatic hydrocarbon metabolites (UPAHMs) and premature menopause. METHODS: This cross-sectional study analyzed 2001-2020 NHANES data, including urinary levels of six PAH metabolites: 1-naphthol (1-NAP), 2-naphthol (2-NAP), 3-fluorene (3-FLU), 2-fluorene (2-FLU), 1-phenanthrene (1-PHE), and 1-pyrene (1-PYR). Premature menopause was self-reported as natural menopause occurring before age 40. Multivariable logistic regression assessed UPAHMs' association with premature menopause, with restricted cubic splines (RCS) evaluating nonlinear trends. Subgroup analyses examined demographic interactions. RESULTS: Among 2,565 participants, 662 reported premature menopause. Multivariable logistic regression showed significant associations between elevated urinary levels of 1-NAP (OR: 1.01, 95% CI: 1.00-1.02, P = 0.02), 2-NAP (OR: 1.01, 95% CI: 1.00-1.02, P = 0.02), and 3-FLU (OR: 1.03, 95% CI: 1.01-1.05, P = 0.01) and increased risk of premature menopause. RCS analysis revealed significant nonlinear relationships for 2-NAP, 3-FLU, 2-FLU, 1-PHE, and 1-PYR with premature menopause risk. White participants showed greater susceptibility to UPAHMs. CONCLUSION Elevated UPAHMs, particularly 1-NAP, 2-NAP, and 3-FLU, were linked to higher premature menopause risk, with nonlinear trends observed. White individuals demonstrated greater vulnerability, emphasizing the need for targeted interventions to reduce PAH exposure.
Humans ; Female ; Cross-Sectional Studies ; United States/epidemiology* ; Polycyclic Aromatic Hydrocarbons/urine* ; Adult ; Middle Aged ; Environmental Pollutants/urine* ; Nutrition Surveys ; Menopause, Premature/urine* ; Young Adult ; Environmental Exposure

Although epilepsy is first known as a disease of seizures and convulsions, most patients with epilepsy also suffer from seizure-associated behavioral abnormalities in motor functions, psychiatric status, and cognition. These neurobehavioral comorbidities may have greater impacts on the quality of life of people with epilepsy than the seizures themselves and can profoundly interfere with the treatment compliance. While repeated seizures often lead to behavioral comorbidities, certain types of comorbid conditions may potentially increase the risk for epileptic seizures, indicative of some common mechanisms that might underlie these two conditions. As such, emerging evidence supports that inflammation within the brain might represent a key component of such a shared mechanism, given that neuroinflammation can be induced by seizures and various behavioral stressors, and in turn may exacerbate both conditions. Among inflammatory pathways that arise after prolonged seizures, PGE₂ signaling via the EP2 receptor promotes cytokine induction, blood-brain barrier disruption, reactive gliosis, neuronal death, and eventually, contributes to behavioral dysfunctions. Pharmacological inhibition of EP2 by small-molecule drug-like antagonists affords broad therapeutic benefits including anti-inflammatory and neuroprotective effects in several rodent seizure models, leading to long-lasting alleviation of neurobehavioral comorbidities, particularly cognitive impairments. Targeting this key inflammatory prostaglandin receptor might provide an adjunctive strategy, along with the current anti-seizure medications, to mitigate cognitive dysfunctions associated with seizure disorders.

Malignant pleural mesothelioma(MPM)is strongly associated with a history of asbestos exposure and is characterized by high malignancy,high mortality,and poor prognosis.Current treatments for MPM are limited and generally suboptimal,resulting in a median overall survival(OS)of approximately one year for MPM patients.However,advancements in treatment options,including surgery,radiotherapy,chemotherapy,immunotherapy and targeted therapy,have brought new hope to patients with MPM.For early-stage MPM patients categorized under the TNM staging system,surgical treatment is feasible and can improve survival rates and quality of life.However,there is still debate regarding the optimal surgical approach for MPM.In addition to surgery,radiotherapy plays a vital role in MPM treatment.It is often used as prophylactic treatment or for alleviating local symptoms in advanced stages.Radiotherapy can also serve as neoadjuvant or adjuvant therapy in surgical contexts.For patients experiencing local progression or isolated distant metastases after systemic treatment,radiotherapy is a viable option.The advent of advanced radiotherapy techniques,such as intensity-modulated radiotherapy(IMRT)and volumetric intensity-modulated arc therapy(VMAT),has significantly improved the precision and efficacy of radiotherapy while minimizing damage to healthy tissues.Furthermore,brachytherapy can relieve pain or act as a localized supplemental therapy.Chemotherapy remains the standard treatment for MPM.The combination of pemetrexed and platinum-based drugs is widely applied as first-line therapy and has been shown to significantly extend survival.However,commonly used second-line regimens often yield suboptimal results.In recent years,immunotherapy has developed rapidly.Dual immunotherapy with nivolumab and ipilimumab has demonstrated impressive clinical efficacy and safety.The combination of immunotherapy and chemotherapy has also notably extended patients'median survival.Multiple clinical trials have confirmed that this combination therapy benefits patients.Currently available targeted therapies for MPM primarily focus on anti-angiogenesis.Bevacizumab combined with chemotherapy has established its position as a first-line treatment.Research on ramucirumab and apatinib suggests that these drugs have certain efficacy and safety profiles.Beyond conventional treatment options,the UV1 cancer vaccine combined with dual immunotherapy offers new hope for patients.Chimeric antigen receptor T(CAR-T)cell therapy is an emerging treatment method being investigated in MPM patients,with phase Ⅰ clinical trials demonstrating good antitumor effects.Additionally,some antibody-drug conjugates are becoming therapeutic options for MPM through precise targeting.Tumor treating fields combined with chemotherapy has also shown efficacy in extending survival.Despite the increasing variety of treatment options for MPM,its diagnosis and treatment still face numerous challenges,including difficulties in early detection,treatment resistance,and a lack of large-scale evidence-based clinical studies.Future research should focus on improving early diagnosis rates,developing new treatment strategies,overcoming resistance,and advancing personalized therapy.Strengthening the integration of basic research and clinical trials will also be essential.Through multidisciplinary collaboration and continuous innovation,it is hoped that more effective and safer treatment options will become available,ultimately improving the prognosis of MPM patients.

BACKGROUND:Pauwels type Ⅲ femoral neck fractures may be subjected to more shear and bending forces,and may be prone to complications such as internal fixation failure,bone nonunion,or femoral head necrosis. There is no consensus on the optimal selection of internal fixation devices.OBJECTIVE:To compare the biomechanical properties of four types of internal fixation methods for Pauwels type Ⅲ femoral neck fracture by finite element analysisMETHODS:Femur CT data of a healthy young volunteer were imported into Mimics software to construct a three-dimensional model of normal femur. Pauwels type Ⅲ femoral neck fracture was simulated based on 70° fracture line. Four types of fracture internal fixation models were optimized and constructed using Geomagic and UG software:conventional inverted triangle hollow screw,femoral neck fixation system,femoral neck fixation system plus anterior or posterior hollow screw treatment. Finally,Ansys software was used to analyze the stress distribution,peak stress,and peak displacement of proximal femur fracture block in four types of different internal fixation models. The displacement distribution and peak displacement of internal fixation device and femoral neckfracture were observed.RESULTS AND CONCLUSION:(1) The peak stress of proximal fracture fragments in the four groups was concentrated near the fracture line. The peak stress in the femoral neck fixation system group was the largest,and that in the conventional inverted triangle hollow screw group was the smallest. (2) The peak displacement of fracture fragments was located at the top of the femoral head. The peak displacement of the conventional inverted triangle hollow screw group was the largest,and that in the femoral neck fixation system+hollow screw (posterior) group was the smallest. (3) The peak displacement of the internal fixation model was located at the top of the model. The peak displacement was maximum in the conventional inverted triangle hollow screw group and minimum in the femoral neck fixation system+hollow screw (posterior) group. (4) The displacement of the fracture surface in the femoral neck fixation system+hollow screw (posterior) group was at the upper part of the fracture end. The peak displacement was the largest in the conventional inverted triangle hollow screw group and the smallest in the femoral neck fixation system+hollow screw (posterior) group. (5) It is indicated that compared with the other three internal fixation methods,femoral neck fixation system+hollow screw (posterior) group showed good biomechanical stability. When Pauwels type Ⅲ femoral neck fracture occurs in a young person,from the point of view of finite element analysis,it may be a more favorable choice to treat the Pauwels type Ⅲ femoral neck fracture.

Objective To study the distribution characteristics of TCM constitutions in the middle-aged and elderly Mongolian population undergoing physical examinations in Inner Mongolia;To analyze the correlation with related risk factors.Methods Health information and related risk factors(including BMI index,lifestyle habits,dietary habits and exercise status)of middle-aged and elderly Mongolian people who visited the physical examination departments of Inner Mongolia Autonomous Region Traditional Chinese Medicine Hospital and Tongliao City Traditional Chinese Medicine Hospital from March 2024 to April 2024 were collected.A total of 213 Mongolian people were surveyed,including 65 people who have lived in Hohhot for more than 2 years and 148 people who have lived in Tongliao for more than 2 years.Through investigation,research and analysis,the distribution characteristics of TCM constitutions in the population and its correlation with related risk factors were observed.Results Constitution distribution:101 people(47.41%)had a moderate constitution.Among the biased constitutions,the phlegm dampness constitution had the highest number of people(64 people,30.05%),with the blood deficiency constitution having the lowest number of people(2 people,0.94%).In the investigation of related risk factors,there was a significant correlation(P<0.01)between phlegm dampness and dietary habits and reduced exercise volume.Moreover,individuals with this constitution tend to have good sleep,reduced physical activity,faster eating and a diet primarily consisting of high-calorie foods(P<0.05).Conclusion The TCM constitution of the Mongolian population in Inner Mongolia is mostly composed of moderate constitution,while the biased constitution is mostly composed of phlegm dampness constitution,which is mainly related to dietary habits and reduced exercise volume.