Osteoarthritis (OA), a highly prevalent degenerative joint disease worldwide, is defined by articular cartilage degradation, abnormal bone remodeling, and persistent chronic inflammation. It severely compromises patients’ quality of life, and currently, there is no radical cure. Abnormal mechanical stress is widely regarded as a core driver of OA pathogenesis, and the exploration of mechanical signal perception and transduction mechanisms has become crucial for deciphering OA’s pathophysiological processes. Piezo1, a key mechanosensitive cation channel belonging to the Piezo protein family, has recently gained significant attention due to its pivotal role in mediating cellular responses to mechanical stimuli in joint tissues. This review systematically examines Piezo1’s expression patterns, regulatory mechanisms, and pathological functions in OA, with a particular focus on its dual roles in modulating chondrocyte homeostasis and bone metabolism disorders, while also delving into the underlying molecular signaling pathways and potential therapeutic implications. Piezo1, consisting of approximately 2 500 amino acids and forming a unique trimeric propeller-like structure, is widely expressed in chondrocytes, osteocytes, mesenchymal stem cells, and synovial cells. It exhibits permeability to cations such as Ca²⁺, K⁺, and Na⁺, and directly responds to membrane tension changes induced by mechanical stimuli like fluid shear stress and mechanical overload. In OA patients and animal models, Piezo1 expression is significantly upregulated, especially in cartilage regions subjected to abnormal mechanical stress (e.g., human temporomandibular joint cartilage). This overexpression is closely associated with aggravated cartilage degeneration, increased chondrocyte apoptosis, accelerated cellular senescence, and intensified inflammatory responses. Mechanical overload and pro-inflammatory cytokines (e.g., IL-1β) are key inducers of Piezo1 upregulation: IL-1β activates the PI3K/AKT/mTOR signaling pathway to enhance Piezo1 expression, forming a pathogenic positive feedback loop that inhibits chondrocyte autophagy, promotes apoptosis, and further accelerates joint degeneration. Mechanistically, Piezo1 mediates OA progression through multiple interconnected pathways. When activated by mechanical stress, Piezo1 triggers excessive Ca²⁺ influx, leading to endoplasmic reticulum stress (ERS) and mitochondrial dysfunction, which directly induce chondrocyte apoptosis. This process involves the activation of downstream signaling cascades such as cGAS-STING and YAP-MMP13/ADAMTS5. YAP, a transcriptional regulator, upregulates the expression of matrix metalloproteinase 13 (MMP13) and aggrecanase (ADAMTS5), thereby accelerating cartilage matrix degradation. Additionally, Piezo1-driven Ca²⁺ overload promotes the accumulation of reactive oxygen species (ROS) and upregulates senescence markers (p16 and p21), accelerating chondrocyte senescence via the p38MAPK and NF-κB pathways. Senescent chondrocytes secrete senescence-associated secretory phenotype (SASP) factors (e.g., IL-6, IL-1β), further amplifying joint inflammation. In terms of bone metabolism, Piezo1 maintains joint homeostasis by promoting the differentiation of fibrocartilage stem cells into chondrocytes and balancing bone formation and resorption through regulating the FoxC1/YAP axis and RANKL/OPG ratio. Therapeutically, targeting Piezo1 shows promising potential. Preclinical studies have demonstrated that Piezo1 inhibitors (e.g., GsMTx4) can reduce joint damage and alleviate pain in OA mice. Simultaneously, siRNA-mediated co-silencing of Piezo1 and TRPV4 (another mechanosensitive channel) decreases intracellular Ca²⁺ concentration, inhibits chondrocyte apoptosis, and promotes cartilage repair. Conditional knockout of Piezo1 using Gdf5-Cre transgenic mice alleviates cartilage degeneration in post-traumatic OA models by downregulating MMP13 and ADAMTS5 expression. Despite existing challenges, such as off-target effects of inhibitors, inefficient local drug delivery, and interindividual genetic variability, strategies like developing selective Piezo1 antagonists, optimizing targeted nanocarriers, and combining Piezo1-targeted therapy with physical therapy provide viable avenues for clinical translation. The authors propose that Piezo1 serves as a critical therapeutic target for OA, and future research should focus on deciphering its context-dependent regulatory networks, developing tissue-specific intervention strategies, and validating their efficacy and safety in clinical trials to address the unmet medical needs of OA patients.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

The study was conducted among 120 general practitioners (GPs) in Shanghai Fengxian District from August 2022 to March 2024, the participants were randomly divided into two age-matched groups with 60 GPs in each group. The intervention group completed a 3-month SPOC (Small Private Online Course)program, including two weeks of narrative medicine theory (concepts, questioning skills, parallel medical record writing, and professionalism) followed by monthly writing practices (three parallel records per month) and group discussions. Both groups performed routine clinical tasks, while the control group received no narrative medicine training. Baseline data were collected, Jefferson Empathy Scale scores, and Doctor-Patient Communication Skills Evaluation Scale scores were evaluated pre- and post-intervention. There were no significant differences in empathy ( P>0.05) or communication skills ( P>0.05) between two groups before the intervention. Post-intervention, both groups showed improved empathy (both P<0.05) and communication skills (both P<0.05) after intervention, while the intervention group were outperforming the control group in both measures ( P<0.05). These findings suggest that SPOC-based narrative competence training effectively enhances the empathy and doctor-patient communication abilities of general practitioners.

Objective:To explore the relationship between internal dimethylformamide (DMF) exposure levels and age and abnormal liver function in occupationally exposed workers, and to provide a reference for the prevention of DMF-induced toxicity.Methods:A total of 388 DMF exposed workers from 4 synthetic leather enterprises in Taicang City were selected by cluster sampling method from May to October 2024, and the data of occupational health examination and biological exposure indicators were collected. The relationship between N-methylcarbyl hemoglobin adduct (NMHb) and age and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT and gamma-glutamyl transpeptidyase (γ-GT) was analyzed by logistic regression, interaction effect analysis, and restricted cubic spline models.Results:The median age of 388 workers was 45.98 years old, the median concentration of NMHb was 165.50 nmol/g Hb, and the abnormal rate of liver function was 40.7% (158/388). NMHb and age of DMF-exposed workers were the influencing factors for liver dysfunction ( P<0.05), and the multiplicative interaction between the two was not statistically significant ( P=0.303), nor was the additive interaction statistically significant [relative excess risk due to interaction (RERI) =0.17 (95% CI: -2.35, 2.69), attributable proportion (AP) =0.03 (95% CI: -0.47, 0.54), synergy index (S) =1.04 (95% CI: 0.54, 2.02) ]. NMHb concentration was positively correlated with the abnormal risk of ALT, AST, AST/ALT, γ-GT and the concentration of ALT, AST, γ-GT ( Poverall <0.05, Pnonlinear>0.05), and negatively correlated with AST/ALT ( Poverall=0.032, Pnonlinear=0.781). Age was negatively correlated with abnormal risk of ALT, AST/ALT and ALT concentration ( Poverall<0.001, Pnonlinear>0.05), and positively correlated with AST/ALT ( Poverall=0.025, Pnonlinear=0.485) . Conclusion:There is a close relationship between NMHb and age of DMF-exposed workers and abnormal liver function. γ-GT can be used as a sensitive index, and special attention should be paid to the change of ALT index in elderly workers. Age should also be considered when AST/ALT is used as the screening indicator.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To analyze the multimorbidity trends and influencing factors of internet addiction and depressive symptoms among middle school students in Zhejiang Province.Methods:From 2018 to 2023, a multistage stratified random cluster sampling method was used to select middle school students aged 12 to 18 in Zhejiang Province. Internet addiction and depression status were measured by the Internet Addiction Scale and the Center for Epidemiologic Studies Depression Scale. When both symptoms were present, it was defined as multimorbidity.The multivariate logistic regression model was used to analyze the influencing factors of multimorbidity among middle school students, and a trend Chi-square test was used to analyze the changing trends of internet addiction, depression and multimorbidity prevalence. Results:A total of 193 505 students were included in the study. From 2018 to 2023, the prevalence of multimorbidity of internet addiction and depressive symptoms among middle school students ranged from 2.7% to 3.5%. The prevalence of internet addiction ranged from 4.7% to 6.0%, while the prevalence of depressive symptoms ranged from 18.7% to 25.1%. Multivariate logistic regression showed that boarding students ( OR=1.34 , 95% CI: 1.26-1.42), low-frequency ( OR=1.59, 95% CI: 1.46-1.73), and high-frequency sugary drink consumption ( OR=3.91, 95% CI: 3.55-4.31) increased the risk of multimorbidity among middle school students. In contrast, higher frequencies of moderate-to-high-intensity exercise (medium: OR=0.54, 95% CI: 0.50-0.58; high: OR=0.49, 95% CI: 0.44-0.55) and sufficient sleep ( OR=0.52, 95% CI: 0.49-0.56) were protective factors. From 2018 to 2023, there was no significant change in the trend of multimorbidity prevalence among middle school students ( χ2trend=3.82, P=0.051). The prevalence of internet addiction showed an upward trend ( χ2trend=20.54, P<0.001), while depressive symptoms showed a downward trend ( χ2trend=181.41, P<0.001). Conclusion:The prevalence of internet addiction and depression symptoms among middle school students in Zhejiang Province remains stable from 2018 to 2023. The prevalence of internet addiction shows an upward trend, while the prevalence of depression symptoms shows a downward trend. The risk of multimorbidity is related to students′ boarding, consumption of sugary drinks, lack of exercise, and insufficient sleep.

Hand degloving injury represents one of the most severe forms of hand trauma, characterised by challenging treatment and a complex prognostic outcome. It is crucial to effectively utilise the degloved tissues in emergency or primary repair of a hand degloving injury. This consensus provides a comprehensive review of the existing literature on definition, classification, emergency assessment, debridement, judgment of skin viability, in situ repair of the degloved skin, and adjunctive treatment for degloving injury of hand. Based on conclusion of both domestic and international experiences, this expert consensus on the classification of hand degloving injury and the emergency repair with the avulsed skin is established, aiming to provide a guidance to surgeons on standardised treatment strategy and improve the management of hand degloving injury.

Objective:To develop and validate a prediction model for medication adherence among patients receiving allergen sublingual immunotherapy (SLIT).Methods:A prospective cross-sectional study was conducted, and a total of 288 patients who received SLIT treatment at an allergy center in the First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital) from December 2023 to July 2024 were assigned to the modeling group. Additionally, 122 patients from August to October 2024 were assigned to the validation group. Data of patients′ general information, medication beliefs, anxiety levels, social support, disease perception, and medication adherence were collected. Single-factor analysis and LASSO regression were utilized to identify potential predictors, and a prediction model for medication adherence was constructed using multifactorial logistic regression. A nomogram was then developed based on the model. The model′s discriminatory ability was evaluated using receiver operating characteristic curve (ROC), the area under curve (AUC), sensitivity, and specificity. The model was then validated in the validation cohort.Results:Single-factor analysis and LASSO regression identified a total of nine predictive factors. Logistic regression revealed that medical belief tendency [ OR (95% CI) =2.420 (1.116-5.248), P=0.025], the somatic control dimension in self-rating anxiety scales [ OR (95% CI)=1.404 (1.241-1.589), P<0.001], the subjective support dimension in social support assessment [ OR (95% CI)=0.784 (0.725-0.847), P<0.001], and the cognitive dimension in illness perception [ OR (95% CI)=0.725 (0.647-0.813), P<0.001] were independent predictors of medication adherence in patients undergoing SLIT. The AUC value of the model was 0.899 (95% CI=0.863-0.934) in the modeling group and 0.882 (95% CI=0.820-0.944) in the validation group, indicating good discriminatory ability. The optimal cutoff value of the model was 0.493, with a sensitivity of 81.1% and specificity of 85.7% in the modeling group, and a sensitivity of 87.3% and specificity of 82.5% in the validation group. Conclusion:The medication adherence prediction model developed in this study for patients undergoing SLIT exhibits good predictive performance and provides valuable guidance for early intervention by clinical healthcare professionals.

Objective:To identify factors associated with depressive symptoms in maintenance hemodialysis patients and to examine the relationship between these symptoms and mortality.Methods:Between January and December 2019, patients who received maintenance hemodialysis in the Blood Purification Center of the Second Affiliated Hospital of Nanjing Medical University were enrolled in a prospective cohort study. Depressive symptoms were assessed using the internationally validated patient health questionnaire-8 (PHQ-8). Sleep quality and anxiety were measured with the Pittsburgh sleep quality index (PSQI) and the generalized anxiety disorder-7 (GAD-7) scale, respectively. Follow-up continued until December 31, 2022, with all-cause mortality as the primary outcome. Ordinal logistic regression was used to identify independent predictors of depression severity. Cox proportional hazards models evaluated the association between depressive symptoms and mortality.Results:A total of 532 maintenance hemodialysis (MHD) patients completed the study. Among them, 177 (33.3%) exhibited depressive symptoms. Compared with patients without depression, those with mild or moderate-to-severe depression were older [median age: 58 (50, 66) vs. 60 (55, 65) vs. 55 (46, 64)], more likely to smoke [35.9% (51/142) vs. 40.0% (14/35) vs.26.2% (93/355)], had poorer sleep quality [PSQI: 9 (6, 13) vs. 12 (9, 17) vs. 5 (3, 9)], and higher anxiety levels [GAD-7: 1 (0, 3) vs. 3 (1, 6) vs. 0 (0, 1)], the differences among the three groups were statistically significant (all P<0.05). Ordinal logistic regression identified smoking status, history of diabetes or cardiovascular disease, hemoglobin level, PSQI score, and GAD-7 score as independent predictors of depression severity ( OR=1.60, 1.80, 1.81, 0.98, 3.67, 8.67; all P<0.05). After a median follow-up of 40 (35, 44) months, 109 patients died, including 66 (60.6%) from cardio-cerebrovascular causes and 24 (22.0%) from infections. Kaplan-Meier analysis revealed significantly lower cumulative survival in the depression group compared to the non-depression group ( P<0.001). Cox regression analysis demonstrated that depressive symptoms remained independently associated with all-cause mortality after adjusting for confounders ( HR=1.06, 95% CI 1.00-1.13, P=0.048), with an even stronger association observed for patients with PHQ-8 scores≥2.9 ( HR=1.10, 95% CI 1.03-1.16, P=0.005). However, the associations between depression and cardio-cerebrovascular mortality ( P=0.111) or infection-related mortality ( P=0.509) were not statistically significant. Conclusions:Depressive symptoms are prevalent among maintenance hemodialysis patients and are independently associated with increased all-cause mortality. Smoking, comorbid diabetes or cardiovascular disease, low hemoglobin level, poor sleep quality, and anxiety are risk factors contributing to depression. Maintenance hemodialysis patients with PHQ-8 scores≥3 should be considered at heightened risk for mortality.

OBJECTIVE T o understand the resistance capability of berberine combined with levofloxacin in vitro to methicillin-resistant Staphylococcus aureus(MRSA).METHODS Totally 100 strains of MRSA were isolated from Shanghai Eighth People's Hospital from Jul.2023 to Jun.2024,the minimum inhibitory concentrations(MICs)of berberine and levofloxacin against the strains were determined by microbroth dilution method.The anti-bacterial effect of the combined use of the two drugs on MRSA was observed.The effects of the single and com-bined use of berberine and levofloxacin on sterilization of MRSA standard strain USA 300-LAC and their influence on cellular morphology were observed.The influence of berberine on mRNA levels of drug resistance genes and ef-flux pump-related genes in the standard strain USA 300-LAC and clinical strains was determined by means of real-time fluorescent quantitative PCR.RESULTS Among the 100 clinical isolates of MRSA,most of them were isola-ted from respiratory tract specimens of respiratory medicine department and geriatrics department,and 75.00％of the strains were resistant to levofloxacin.The MICs of both berberine and levofloxacin against the standard strain USA300-LAC were 128 μg/ml;the MICs against the clinical MRSA isolates were 64 to 1024 μg/ml and 0.125 to 256 μg/ml,respectively.Berberine combined with levofloxacin showed additive effect on 17(44.74％)strains of MRSA.The combined use of the two drugs showed the most remarkable in vitro antibacterial effect.The cellular structures of the strains were unclear and the contents of bacterial bodies increased when berberine and levofloxacin were used in combination.Berberine showed various degree of inhibitory effect on gyrA,gyrB,grlA and nor A genes.CONCLUSIONS Berberine is capable of resisting the MRSA and shows synergistic or additive effect with levofloxacin.The combined use of the two drugs may reduce the MIC against levofloxacin,destroy the morpholog-ical structure,and inhibit the expression of gyrA,gyrB,grlA and nor A genes.