BACKGROUND: Approximately 40% of individuals with diabetes worldwide are at risk of developing diabetic kidney disease (DKD), which is not only the leading cause of kidney failure, but also significantly increases the risk of cardiovascular disease, causing significant societal health and financial burdens. This study aimed to describe the burden of DKD and explore its cross-country epidemiological status, predict development trends, and assess its risk factors and sociodemographic transitions. METHODS: Based on the Global Burden of Diseases (GBD) Study 2021, data on DKD due to type 1 diabetes (DKD-T1DM) and type 2 diabetes (DKD-T2DM) were analyzed by sex, age, year, and location. Numbers and age-standardized rates were used to compare the disease burden between DKD-T1DM and DKD-T2DM among locations. Decomposition analysis was used to assess the potential drivers. Locally weighted scatter plot smoothing and Frontier analysis were used to estimate sociodemographic transitions of DKD disability-adjusted life years (DALYs). RESULTS: The DALYs due to DKD increased markedly from 1990 to 2021, with a 74.0% (from 2,227,518 to 3,875,628) and 173.6% (from 4,122,919 to 11,278,935) increase for DKD-T1DM and DKD-T2DM, respectively. In 2030, the estimated DALYs for DKD-T1DM surpassed 4.4 million, with that of DKD-T2DM exceeding 14.6 million. Notably, middle-sociodemographic index (SDI) quintile was responsible for the most significant DALYs. Decomposition analysis revealed that population growth and aging were major drivers for the increased DKD DALYs in most regions. Interestingly, the most pronounced effect of positive DALYs change from 1990 to 2021 was presented in high-SDI quintile, while in low-SDI quintile, DALYs for DKD-T1DM and DKD-T2DM presented a decreasing trend over the past years. Frontiers analysis revealed that there was a negative association between SDI quintiles and age-standardized DALY rates (ASDRs) in DKD-T1DM and DKD-T2DM. Countries with middle-SDI shouldered disproportionately high DKD burden. Kidney dysfunction (nearly 100.0% for DKD-T1DM and DKD-T2DM), high fasting plasma glucose (70.8% for DKD-T1DM and 87.4% for DKD-T2DM), and non-optimal temperatures (low and high, 5.0% for DKD-T1DM and 5.1% for DKD-T2DM) were common risk factors for age-standardized DALYs in T1DM-DKD and T2DM-DKD. There were other specific risk factors for DKD-T2DM such as high body mass index (38.2%), high systolic blood pressure (10.2%), dietary risks (17.8%), low physical activity (6.2%), lead exposure (1.2%), and other environmental risks. CONCLUSIONS DKD markedly increased and varied significantly across regions, contributing to a substantial disease burden, especially in middle-SDI countries. The rise in DKD is primarily driven by population growth, aging, and key risk factors such as high fasting plasma glucose and kidney dysfunction, with projections suggesting continued escalation of the burden by 2030.
Humans ; Global Burden of Disease ; Risk Factors ; Male ; Female ; Disability-Adjusted Life Years ; Diabetic Nephropathies/epidemiology* ; Middle Aged ; Diabetes Mellitus, Type 2/epidemiology* ; Adult ; Diabetes Mellitus, Type 1/complications* ; Aged ; Adolescent ; Young Adult ; Quality-Adjusted Life Years

Objective:To analyze the revision strategies for failed atlantoaxial dislocation (AAD) surgery.Methods:A retrospective analysis was conducted on 145 patients who underwent revision surgery for AAD at the General Hospital of Southern Theatre Command of PLA between September 2009 and December 2023. The cohort included 74 males and 71 females, with a mean age of 43±16 years (range, 6-72 years). The initial surgical approaches were: anterior 31 cases, posterior 114 cases. Based on imaging assessments of immediate postoperative reduction and fusion status prior to revision, the cases of failure were classified into reduction-nonfusion type (22 cases), nonreduction-fusion type (31 cases), and nonreduction-nonfusion type (92 cases). Among the nonreduction-nonfusion cases, 39 had initial surgery with internal fixation for reduction, while 53 had initial surgery with simple decompression (posterior arch resection, foramen magnum decompression) without reduction. In the nonreduction-fusion cases, 8 cases had spot fusion and 23 had extensive fusion. Japanese Orthopaedic Association (JOA) scores were compared before and after revision, and complication rates were observed.Results:All patients successfully underwent surgery. The revision approaches included: anterior (anterior fixation and fusion 52 cases, anterior implant removal combined anterior fixation and fusion 4 cases, transoral odontoidectomies 16 cases, anterior implant removal combined transoral odontoidectomy 2 cases), posterior (posterior fixation and fusion 2 cases, posterior implant removal combined posterior fixation and fusion 22 cases), and combined anterior-posterior (posterior implant removal combined anterior fixation and fusion 18 cases, anterior implant removal combined posterior fixation and fusion 25 cases, posterior implant removal combined transoral odontoidectomy 5 cases). Operative time was 254.20±107.63 min (range, 90-660 min), and blood loss was 218.83±172.17 ml (range, 20-800 ml). Except for 3 patients who died due to postoperative complications, all patients were followed up for a duration of 12±11 months (range, 3-60 months). Six patients who failed to achieve bony fusion after the initial revision surgery underwent a second revision due to poor reduction (1 case), infection (1 case), suboptimal implant position (3 cases), and graft nonunion (1 case). All three patients with bony fusion after the initial revision surgery underwent a second revision due to poor reduction. Following the second revision surgery, none of the 9 patients exhibited graft nonunion or spinal cord compression. The 136 successful initial revision cases had a final follow-up JOA score of 14.75±2.00, significantly higher than the preoperative score of 11.93±2.92 ( t=-18.869, P<0.001). Conclusions:Revision surgery for AAD should take into account the immediate postoperative reduction status and fusion status prior to revision. An appropriate revision strategy should be selected to achieve satisfactory reduction and bony fusion.

Brain-computer interface (BCI) has high application value in the field of healthcare. However, in practical clinical applications, convenience and system performance should be considered in the use of BCI. Wearable BCIs are generally with high convenience, but their performance in real-life scenario needs to be evaluated. This study proposed a wearable steady-state visual evoked potential (SSVEP)-based BCI system equipped with a small-sized electroencephalogram (EEG) collector and a high-performance training-free decoding algorithm. Ten healthy subjects participated in the test of BCI system under simplified experimental preparation. The results showed that the average classification accuracy of this BCI was 94.10% for 40 targets, and there was no significant difference compared to the dataset collected under the laboratory condition. The system achieved a maximum information transfer rate (ITR) of 115.25 bit/min with 8-channel signal and 98.49 bit/min with 4-channel signal, indicating that the 4-channel solution can be used as an option for the few-channel BCI. Overall, this wearable SSVEP-BCI can achieve good performance in real-life scenario, which helps to promote BCI technology in clinical practice.
Brain-Computer Interfaces ; Humans ; Evoked Potentials, Visual/physiology* ; Electroencephalography ; Wearable Electronic Devices ; Algorithms ; Signal Processing, Computer-Assisted ; Adult ; Male

Objective:To explore the impact of adolescent mental health status on smartphone addiction, and construct a predictive model for smartphone addiction based on the eXtreme Gradient Boosting(XGBoost) algorithm and multivariate Logistic regression.Methods:In April 2023, a cross-sectional survey was conducted among 14 666 adolescents.All participants were systematically evaluated using a self-developed general information questionnaire, the middle school student mental health scale(MSSMHS), the adolescents self-harm scale(ASHS), the interaction anxiousness scale(IAS), the mobile phone addiction index(MPAI), the middle school students shame scale(MSSS), the UCLA loneliness scale(UCLA-LS), the multidimensional peer victimization scale(MPVS), and the basic psychological needs scale(BPNS).R software version 4.3.2 was used for data analysis. Participants were randomly divided into training set and validation set at the ratio of 7∶3.The XGBoost model and multivariate logistic regression model were constructed to predict the risk of smartphone addiction, and a nomogram was plotted.Model performance was evaluated using the Hosmer-Lemeshow test, area under the curve(AUC), and accuracy(ACC).Results:(1) A total of 14 036 high school students were included in the study, with 5 069(36.1%) exhibited smartphone addiction.The training set comprised 9 826 students, with 3 549(36.1%) being smartphone addicts.The validation set included 4 210 students, with 1 520(36.1%) being smartphone addicts.(2) The XGBoost model identified shame-proneness and social anxiety as the two main predictors of smartphone addiction.(3) Multivariate Logistic regression analysis revealed that anxiety( B=0.328, OR(95% CI)=1.39(1.07-1.81), P=0.015), interpersonal sensitivity( B=0.311, OR(95% CI)=1.36(1.05-1.77), P=0.018), learning pressure( B=0.606, OR(95% CI)=1.83(1.46-2.31), P<0.001), mood swings( B=0.775, OR(95% CI)=2.17(1.70-2.78), P<0.001), social anxiety( B=0.024, OR(95% CI)=1.02(1.01-1.04), P<0.001), shame-proneness( B=0.049, OR(95% CI)=1.05(1.04-1.06), P<0.001), and peer victimization( B=0.037, OR(95% CI)=1.04(1.02-1.06), P<0.001) were significant predictors of smartphone addiction.(4) The ACC and AUC values of the XGBoost model were 0.890 and 0.929 in the training set, and 0.865 and 0.864 in the validation set, respectively.The multivariate Logistic regression model achieved ACC and AUC values of 0.870 and 0.854 in the training set, and 0.867 and 0.859 in the validation set, respectively. Conclusion:Anxiety, interpersonal sensitivity, learning pressure, mood swings, social anxiety, shame-proneness, and peer victimization are identified risk predictors of smartphone addiction in high school adolescents.

Objective:To investigate the prevalence and severity of symptom burden among long-term survivors of oropharyngeal cancer after radiotherapy, to identify core symptom clusters, and to explore their correlation with quality of life.Methods:A previous retrospective study was conducted by the Cancer Hospital, Chinese Academy of Medical Sciences on patients with oropharyngeal cancer who underwent radiotherapy between January 2010 and December 2020. Patients who were still alive as of December 2023 were further followed and analyzed. From December 2023 to August 2024, symptom burden and quality of life were assessed using the Chinese version of the MD Anderson Symptom Inventory–Head and Neck Module (MDASI-HN) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Exploratory factor analysis (principal component analysis with Promax rotation) were used to identify symptom clusters. Spearman correlation analysis was performed to explore the relationship between total symptom cluster scores and standardized domain scores of quality of life. Multivariate linear regression analysis was further employed to determine the relationship between identified symptom clusters and overall quality of life.Results:A total of 273 patients were included, with a median follow-up duration of 6.2 years (range: 3.5-14.5 years) and a median age of 61 years (range: 27-88 years) at follow-up. The top 5 incidence rates of symptom reported by patients were mucus problems in the mouth or throat (147 cases, 53.8%), dental or gum issues (143 cases, 52.4%), xerostomia (140 cases, 51.3%), difficulty swallowing or chewing (95 cases, 34.8%), and taste disturbance (79 cases, 28.9%). Among them, xerostomia was the most serious symptom. The most frequently reported interference was impact on work (including household chores) (55 cases, 20.1%). Exploratory factor analysis identified 3 symptom clusters: fatigue-nausea cluster, eating-voice cluster, and xerostomia-sleep cluster, all of which were significantly correlated with lower overall quality of life of patients (all P<0.001). Conclusion:Long-term survivors of oropharyngeal cancer after radiotherapy experience substantial symptom burden. The fatigue-nausea, eating-voice, and xerostomia-sleep clusters are the core symptom clusters impacting quality of life.

The glymphatic system (GS) is an essential waste clearance pathway in the central nervous system, playing a crucial role in the occurrence and progression of cerebrovascular diseases. In recent years, advancements in imaging techniques have provided important tools for assessing the structure and dynamics of the GS, further advancing its research in patients with cerebrovascular disease. This article reviews various imaging evaluation methods and clinical significance of GS in patients with cerebrovascular disease, aiming to provide a new perspective for a deeper understanding of the pathophysiological mechanisms and clinical practice of cerebrovascular disease.

OBJECTIVE:To assess the efficacy and safety of acupuncture in treating postmenopausal osteoporosis.METHODS:Clinical randomized controlled trials on acupuncture for postmenopausal osteoporosis were retrieved from databases including CNKI,VIP,WanFang,China Biomedical Literature Service System,Web of Science,PubMed,Embase,and Cochrane Library.The search period was from the inception of the database to July 23,2024.The quality of evidence and risk of bias of the included studies were assessed using the GRADEprofiler and the revised Cochrane risk-of-bias tool for randomized trials(RoB 2.0).Meta-analysis was performed using StataSE 15 and TSA 0.9.5,along with heterogeneity analysis,sensitivity analysis,subgroup analysis,publication bias analysis,trim-and-fill analysis,and trial sequential analysis.RESULTS:The study included 19 randomized controlled trials involving a total of 1 464 patients.(1)The meta-analysis revealed that compared with conventional therapies,acupuncture significantly increased the total effective rate(RR=1.25,95％confidence interval[1.19,1.32],P＜0.001),lumbar spine L2-L4 bone mineral density(mean difference=0.08,95％confidence interval[0.05,0.11],P＜0.001),and estrogen levels(standard mean difference=0.55,95％confidence interval[0.30,0.81],P＜0.001).Additionally,acupuncture increased bone mineral density and gonadotropin levels in the femoral neck,greater trochanter,and Ward's triangle,reduced visual analogue scale scores,and improved bone metabolism without significantly increasing the incidence of adverse events.(2)Subgroup analysis of the main outcome indicators showed no significant difference between the treatment and control groups when the body mass index was greater than 23.9 kg/m2 and the total treatment duration was 6 months.All other treatment subgroups were significantly superior to the control group.(3)Publication bias analysis indicated a significant risk of publication bias in the overall efficacy;however,a trim-and-fill analysis showed that this risk did not significantly impact the reliability of the conclusions.Publication bias analysis showed no significant risk of publication bias in the bone mineral density values of lumbar spine L2-L4 and estradiol levels.(4)The sequential analysis of the trial further confirmed that acupuncture significantly increased the overall effective rate,bone mineral density values at the lumbar spine L1-L4,and estradiol levels.CONCLUSION:Acupuncture is an effective and safe treatment for postmenopausal osteoporosis.More rigorously designed and high-quality studies are needed in the future to verify this conclusion.

Reporting guidelines are structured checklists for researchers to follow when reporting spe-cific types of studies.As researches conducted in real-world settings to address practical issues,implementa-tion research has stringent requirements for the replicability of result and the transparency of reporting,making its reporting guidelines particularly important.This paper systematically introduces the reporting guidelines in the field of implementation science,outlines their classification systems and scopes of applica-tion,and focuses on explaining the core characteristics and functions of five key reporting guidelines,inclu-ding the Standards for Reporting Implementation Studies(StaRI),Reporting guidelines for implementation and operational research,the Template for Intervention Description and Replication(TIDieR),the Frame-work for Reporting Adaptations and Modifications-Enhanced(FRAME),and recommendations for specifying and reporting implementation strategies.Furthermore,combined with the PEDALs research paradigm in im-plementation science,this paper further clarifies the specific application pathways for reporting guidelines and discusses directions for refinement,aiming to provide references for researchers to select appropriate reporting guidelines.

Objective:To explore the impact of adolescent mental health status on smartphone addiction, and construct a predictive model for smartphone addiction based on the eXtreme Gradient Boosting(XGBoost) algorithm and multivariate Logistic regression.Methods:In April 2023, a cross-sectional survey was conducted among 14 666 adolescents.All participants were systematically evaluated using a self-developed general information questionnaire, the middle school student mental health scale(MSSMHS), the adolescents self-harm scale(ASHS), the interaction anxiousness scale(IAS), the mobile phone addiction index(MPAI), the middle school students shame scale(MSSS), the UCLA loneliness scale(UCLA-LS), the multidimensional peer victimization scale(MPVS), and the basic psychological needs scale(BPNS).R software version 4.3.2 was used for data analysis. Participants were randomly divided into training set and validation set at the ratio of 7∶3.The XGBoost model and multivariate logistic regression model were constructed to predict the risk of smartphone addiction, and a nomogram was plotted.Model performance was evaluated using the Hosmer-Lemeshow test, area under the curve(AUC), and accuracy(ACC).Results:(1) A total of 14 036 high school students were included in the study, with 5 069(36.1%) exhibited smartphone addiction.The training set comprised 9 826 students, with 3 549(36.1%) being smartphone addicts.The validation set included 4 210 students, with 1 520(36.1%) being smartphone addicts.(2) The XGBoost model identified shame-proneness and social anxiety as the two main predictors of smartphone addiction.(3) Multivariate Logistic regression analysis revealed that anxiety( B=0.328, OR(95% CI)=1.39(1.07-1.81), P=0.015), interpersonal sensitivity( B=0.311, OR(95% CI)=1.36(1.05-1.77), P=0.018), learning pressure( B=0.606, OR(95% CI)=1.83(1.46-2.31), P<0.001), mood swings( B=0.775, OR(95% CI)=2.17(1.70-2.78), P<0.001), social anxiety( B=0.024, OR(95% CI)=1.02(1.01-1.04), P<0.001), shame-proneness( B=0.049, OR(95% CI)=1.05(1.04-1.06), P<0.001), and peer victimization( B=0.037, OR(95% CI)=1.04(1.02-1.06), P<0.001) were significant predictors of smartphone addiction.(4) The ACC and AUC values of the XGBoost model were 0.890 and 0.929 in the training set, and 0.865 and 0.864 in the validation set, respectively.The multivariate Logistic regression model achieved ACC and AUC values of 0.870 and 0.854 in the training set, and 0.867 and 0.859 in the validation set, respectively. Conclusion:Anxiety, interpersonal sensitivity, learning pressure, mood swings, social anxiety, shame-proneness, and peer victimization are identified risk predictors of smartphone addiction in high school adolescents.

Objective To establish animal models by implanting Gynemesh polypropylene mesh and Mersilene tape into the abdominal walls of rats,followed by conducting mechanical experiments and performing HE staining on abdominal wall tissues at 30 and 90 days post-implantation,respectively,in order to evaluate the biomechanical properties and histocompatibility of the two types of meshes.Methods The Gynemesh mesh and Mersilene tape were implanted into the abdominal wall of adult female rats(n=10)using W6977M polyester non-absorbable sutures and V-Loc absorbable sutures.The rats were randomly assigned to either a 30-day group or a 90-day group(n=5 per group)based on different experimental time points.Mechanical tests were conducted at these time points to evaluate the ultimate load required for avulsion of the meshes from the abdominal wall.Following the mechanical experiments,the tissues surrounding the meshes were harvested for hematoxylin and eosin(HE)staining.The inflammatory response,neovascularization,and fibroblast proliferation in the tissues were scored to compare the histocompatibility of the two types of meshes.Results(1)In the 30-day group,the ultimate load values were as follows:Gynemesh+6977(14.96±2.22)N,Gynemesh+V-Loc(12.73±1.11)N,Mersilene+6977(10.65±0.91)N,and Mersilene+V-Loc(8.70±1.18)N.No statistically significant difference was observed in the ultimate load between the Gynemesh+6977 and Gynemesh+V-Loc groups(P=0.12),whereas statistically significant differences were noted among the other groups(P<0.05).(2)In the 90-day group,the ultimate load values were as follows:Gynemesh+6977(18.97±0.59)N,Gynemesh+V-Loc(18.18±0.54)N,Mersilene+6977(13.87±0.67)N,and Mersilene+V-Loc(10.41±0.73)N.No statistically significant difference was observed in the ultimate load between the Gynemesh+6977 and Gynemesh+V-Loc groups(P=0.06),while statistically significant differences were noted among the other groups(P<0.05).(3)The ultimate load at 90 days for each group was significantly greater than that at 30 days,with statistically significant differences observed across all groups(P<0.05).(4)In the 30-day group,Gynemesh exhibited a lower inflammatory response compared to Mersilene tape(2.0±0.69 vs.3.10±0.71,P<0.05),with no statistically significant differences in neovascular-ization or fibroblast proliferation(2.37±0.61 vs.2.40±0.62,P=0.84;2.43±0.73 vs.2.63±0.67,P=0.27).In the 90-day group,Gynemesh demonstrated a lower inflammatory response score(1.10±0.66 vs.2.00±0.74,P<0.05),reduced fibroblast proliferation(2.87±0.68 vs.3.27±0.67,P<0.05),and no significant difference in neovascular proliferation(2.20±0.55 vs.2.13±0.68,P=0.68)compared to Mersilene tape.(5)The inflam-matory response for both mesh types was higher in the 30-day group compared to the 90-day group(Gynemesh group:2.0±0.69 vs.1.10±0.66,P<0.05;Mersilene group:3.13±0.73 vs.2.0±0.74,P<0.05).Additionally,the degree of fibroblast proliferation was lower in the 30-day group than in the 90-day group(Gynemesh group:2.43±0.73 vs.2.87±0.68,P<0.05;Mersilene group:2.63±0.67 vs.3.27±0.69,P<0.05).However,there was no statistically significant difference in neovascularization proliferation between the two groups(Gynemesh group:2.53±0.74 vs.2.47±0.74,P=0.81;Mersilene group:2.40±0.62 vs.2.13±0.68,P=0.12).Conclusion Compared with Mersilene tape,Gynemesh polypropylene mesh exhibits superior tensile strength and enhanced biocompatibility.