Knee osteoarthritis (KOA) is a common chronic degenerative disease that not only causes pain and reduces the quality of life for patients but also imposes a significant societal burden. Clinical pathways can be developed by referencing recommendations from clinical practice guidelines to localize guidelines within the context of integrated traditional Chinese and western medical systems. However, existing clinical pathways suffer from shortcomings such as deficiencies in integrated traditional Chinese and western medical diagnosis and treatment, inadequate shared decision-making between healthcare providers and patients, and suboptimal visualization of clinical pathways. This study aimed to address and optimize the clinical pathway of KOA by comprehensively organizing and localizing the recommended guidelines. The concept of integrated traditional Chinese and western medicine was reflected through the construction of a path of joint decision-making between doctors and patients, emphasizing the coexistence of diagnosis and screening, the combination of clinical and imaging staging, joint decision-making between doctors and patients, and treatment stages. This pathway emphasizes patient-centered approach, with pain relief and functional rehabilitation running parallel, achieving the implementation of evidence-based concepts in practical medical practice. It provides a concrete basis for joint decision-making between doctors and patients in the integrated treatment of KOA with traditional Chinese and western medicine, which helps to improve diagnosis and treatment efficiency and patient quality of life.

ObjectiveTo investigate the optimal ratio of goat horn replacing antelope horn in Fufang Lingjiao Jiangya pills and the blood pressure-lowering mechanism of this medicine. MethodsThe blood pressure-lowering efficacy of Fufang Lingjiao Jiangya pills with varying proportions of goat horn replacing antelope horn was evaluated on spontaneous hypertensive rats （SHR）. In this experiment， 50 SHR rats were randomly grouped as follows： model （n=8）， captopril （0.01 g·kg^-1） （n=6）， low-dose blank Fufang Lingjiao Jiangya pills （0.342 g·kg^-1） （n=6）， high-dose blank Fufang Lingjiao Jiangya pills （0.684 g·kg^-1） （n=6）， low-dose antelope horn-containing Fufang Lingjiao Jiangya pills （0.378 g·kg^-1） （n=6）， high-dose antelope horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1） （n=6）， low-dose goat horn-containing Fufang Lingjiao Jiangya pills （0.378 g·kg^-1） （n=6）， and high-dose goat horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1） （n=6）. Additionally， 8 WKY rats were used as the normal group. Drugs were administered by gavage for 4 weeks while an equal volume of distilled water was administered for the normal and model groups. Blood pressure was measured before administration， 3 h post administration， and biweekly thereafter. In the experiment for Fufang Lingjiao Jiangya pills with goat horn replacing antelope horn in different proportions， 48 SHR rats were randomly grouped as follows： model， blank Fufang Lingjiao Jiangya pills （0.684 g·kg^-1）， antelope horn-containing Fufang Lingjiao Jiangya pills （0.756 g·kg^-1）， 2× goat horn-containing Fufang Lingjiao Jiangya pills （0.824 g·kg^-1）， 4× goat horn Fufang Lingjiao Jiangya pills （0.969 g·kg^-1）， and 6× goat horn Fufang Lingjiao Jiangya pills （1.112 g·kg^-1）. The normal group included 8 WKY rats， and the normal group and model group received an equal volume of distilled water. The treatment lasted for 2 weeks， and blood pressure was recorded at various time points （pre-administration， 3 h post administration， and on days 4， 7， 10， and 14 of administration）. Serum levels of angiotensin-converting enzyme （ACE）， angiotensin Ⅱ（Ang Ⅱ）， renin， and interleukin-6 （IL-6） were measured by enzyme-linked immunosorbent assay. Histopathological changes in the heart， kidney， and thoracic aorta were observed by hematoxylin-eosin staining. The protein levels of ACE2， angiotensin Ⅱ type 1 receptor （AT1R）， and angiotensinogen （AGT） in the kidney tissue were determined by Western blot， while the expression of nuclear factor （NF）-κB p65 and Toll-like receptor 4 （TLR4） in the thoracic aorta tissue was assessed by immunohistochemistry. ResultsCompared with the model group， all treatment groups showed lowered blood pressure （P<0.05， P<0.01）， and the 6× goat horn-containing Fufang Lingjiao Jiangya pills group showed consistent blood pressure-lowering effect with the antelope horn-containing Fufang Lingjiao Jiangya pills group. Compared with the normal group， the model group showed elevated serum levels of ACE， Ang Ⅱ， renin， and IL-6， while the elevations were declined in the Fufang Lingjiao Jiangya pills groups （P<0.05， P<0.01）. Pathological changes in the heart， kidney， and thoracic aorta were alleviated in all the treatment groups， with the 6× goat horn- and antelope horn-containing Fufang Lingjiao Jiangya pills groups exhibited the best effect. Western blot and immunohistochemistry results showed that all the treatment groups exhibited down-regulated protein levels of AT1R， AGT， NF-κB p65， and TLR4 and up-regulated protein levels of ACE2 （P<0.05， P<0.01） compared with model group， with the 6×goat horn- and antelope horn-containing Fufang Lingjiao Jiangya pills groups showcasing the best effect. ConclusionReplacing antelope horn with 6×goat horn in Fufang Lingjiao Jiangya pills can achieve consistent blood pressure-lowering effect with the original prescription. The prescription may exert the effect by inhibiting the renin-angiotensin-aldosterone system （RAAS） and TLR4/NF-κB signaling pathways.

Objective:To evaluate left ventricular systolic function in patients with systemic scleroderma (SSc) with normal left ventricular ejection fraction using pressure-strain loop (PSL) .Methods:To collect 30 patients with SSc who were treated in the Rheumatology and Immunology Department of Jining Medical University from January 2022 to March 2024 as the observation group, 30 healthy volunteers were selected as the control group after 1:1 matching with the observation group according to the age ±3 years old and the same gender. Clinical and ultrasound data were collected, PSL was used to evaluate and compare the differences between the two groups in left ventricular longitudinal strain (GLS), global work index (GWI), global useful work (GCW), global useless work (GWW) and global work efficiency (GWE), and the statistically significant variables were analyzed by multivariate logistic regression to analyze the independent predictors of early left ventricular function impairment in patients with SSc,and constructed receiver operating characteristic (ROC) curve to analyze the predictive value of GLS, GWI, GCW, GWW and GWE in early left ventricular function impairment in SSc patients.Results:Compared with the control group, the observation group GLS,GWI, GCW and GWE decreased( P<0.05), while the GWW increased( P<0.05). Multivariate logistic regression analysis showed that GLS[ OR(95% CI)=0.51(0.26, 1.02), P=0.055]、GWI[ OR(95% CI)=1.00(0.99, 1.01), P=0.969)、GCW[ OR(95% CI)=1.00(0.99, 1.02), P=0.771]、GWW[ OR(95% CI)=0.90(0.81, 1.01), P=0.075]and GWE[ OR(95% CI)=0.02(0.00, 0.55), P=0.022], in which GWE had the highest significance in predicting left ventricular myocardial work in SSc patients. ROC curve showed that compared with GLS, GWI, GCW and GWW, the area under GWE curve (0.953) was the largest, and the sensitivity of GWE≤94% to predict myocardial damage in SSc patients was 80.0%, and the specificity was 93.3%. The results of the repeatability test showed that the reproducibility of the intra-observer and inter-observer measurements was good. Conclusion:The PSL provides a new method for the quantitative assessment of early left ventricular systolic function impairment in patients with SSc, and GWE can be used as a sensitive index to predict early left ventricular systolic function impairment in patients with SSc.

Objective To explore the correlation between the ratio of free triiodothyronine/free thyroxine(FT3/FT4)and the early-phase insulin secretion index(ΔI30/ΔG30)in type 2 diabetes mellitus(T2DM)patients with normal thyroid function.Methods 200 patients with T2DM with normal thyroid function in Hebei General Hospital from September 2019 to June 2021 were selected and divided into the Q1 group with FT3/FT4≤0.26(n=67),the Q2 group with 0.27≤FT3/FT4≤0.29(n=67),and the Q3 group with FT3/FT4≥0.30(n=66)according to the tertiles of the FT3/FT4.The general data,biochemical indicators and islet functions of the three groups were compared,and the relationship between the FT3/FT4 ratio and the ΔI30/ΔG30 as well as the islet β cell function was analyzed.Results The fasting insulin(FIns),2 h postprandial insulin(2 hIns),homeostatic model assessment of islet β cell(HOMA-β)and area under the curve of insulin(AUCI)in Q3 group were higher than those in Q1 and Q2 groups(P<0.05),2 h postprandial blood glucose(2 hPG)in Q3 group was lower than those in Q1 and Q2 groups(P<0.05).Systolic blood pressure in Q2 group was higher than those in Q1 group(P<0.05).Compared with Q1 group,diastolic blood pressure,body mass index(BMI),alanine aminotransferase(ALT),fasting C-peptide(FC-P),area under curve of C-P(AUCC),2 h postprandial C-peptide(2 hC-P)and ΔI30/ΔG30 in Q3 group were significantly higher(P<0.05),and HbA1c was significantly lower(P<0.05).Spearman correlation analysis showed that Δ I30/Δ G30,HOMA-β,AUCI,AUCC and HOMA-IR were positively correlated with BMI,ALT,FC-P,2 hC-P,FIns,2 hIns and FT3/FT4(P<0.05),it was negatively correlated with HbA1c and 2 hPG(P<0.05).Linear regression analysis showed that ΔI30/ΔG30,HOMA-β,AUCI and AUCC were the influencing factors of FT3/FT4 after adjusting for confounding factors.Conclusions ΔI30/ΔG30,HOMA-β,AUCI and AUCC are the influencing factors of FT3/FT4 in T2DM patients with normal thyroid function,suggesting that FT3/FT4 is higher in patients with better islet β cell secretion function.

Cognitive dysfunction has emerged as a significant health challenge in aging societies, among which Alzheimer's disease(AD)and related dementia have become one of the leading causes of death among the elderly.These diseases are characterized by insidious onset and progressive deterioration, often reaching irreversible advanced stages at initial diagnosis, making early detection and prevention imperative.As the frontline of public health management, communities bear the responsibility for screening and managing major chronic diseases.However, community-based cognitive screening in China still remains in its nascent stages, lacking systematic management and prevention guidelines.This guideline, established under a multidisciplinary collaborative framework and adhering to evidence-based medicine principles, systematically reviews and analyzes the latest clinical evidence worldwide.Utilizing the GRADE(Grading of Recommendations Assessment, Development and Evaluation)system to evaluate evidence quality and following the RIGHT(Reporting Items for Practice Guidelines in Healthcare)statement for standardized guideline development, it ultimately presents 17 recommendations through three rounds of Delphi expert consultations.The core recommendations of this guideline is mainly to use digital cognitive scales to conduct large-scale community cognitive screening for the active individuals aged 60 or above.Stratification and staging should be performed based on screening results, and digital cognitive files with quantified risk factor grading should be established, followed by the formulation of personalized artificial intelligence(AI)prevention and control programs.This guide is the first in China and internationally to propose a quantitative grading system for low, medium, and high-risk factors associated with AD and vascular dementia(VD). It aims to provide standardized principles and practical pathways to advance China's ambitious goals: achieving ≥80% public awareness of dementia prevention knowledge, ≥80% cognitive screening rate among the elderly, ≥80% intervention guidance rate for at-risk populations, and ≥50% medical consultation rate for suspected cognitive impairment cases.

Objective To investigate the effect of high,middle and low dose dexmedetomidine combined with sufentanil on perioperative analgesia and sleep quality in patients with oral cancer.Methods A total of 158 patients undergoing oral cancer surgery in the hospital from January 2023 to June 2024 were selected and divided into group A[n=53,0.6 μg/(kg h)dexmedetomidine+2 μg/kg sufentanil]and group B[n=53,0.4 μg/(kg h)dexmedetomidine+2 μg/kg sufentanil],Group C[n=52,0.2μg/(kg·h)dexmedetomidine+2 μg/kg sufentanil]by random number table method.Stress response indexes[brain-derived neurotrophic factor(BDNF),cortisol(Cor),interleukin-6(IL-6)],bifrequency index and analgcsia nociccption index(BIS,ANI),pain level,T lym-phocyte subsets CD3+,CD4+,CD8+levels,Richards Campbell Sleep Scale(RCSQ)score and adverse reactions were compared between the two groups.Results Compared with 12 h before surgery,serum levels of BDNF,Cor and IL-6 in 3 groups were decreased 48 h after surgery,group A was lower than group B,group C,group B was lower than group C(P＜0.05).Compared with T0,BIS at T1～T3 were significantly different between the 3 groups(P＜0.05),BIS at T1～T3 were lower than those at T0(P＜0.05),and there was no significant difference in BIS at the same time between the 3 groups(P＞0.05),from T,to T3,ANI was higher than that at T0,and ANI in group A was higher than that in group B and group C(P＜0.05).Compared with the preoperative results,the pain scores of the 3 groups were decreased at 1 h,6 h,24 h and 48 h after operation,and the pain scores of group A were lower than those of group B and C,and the pain scores of group B were lower than those of group C(P＜0.05).After operation,CD3+and CD4+were decreased in all 3 groups,group A was lower than group B and group C,group B was lower than group C(P＜0.05),and CD8+was increased in all 3 groups,group A was higher than group B and group C,group B was higher than group C(P＜0.05).Compared with 1 day before the operation,the sleep quality scores of the three groups on the night after the operation and the second night after the operation were all decreased,group A was lower than group B and group C,and group B was lower than group C(P＜0.05).The incidence of hypotension and sinus bradycardia in group A was higher than that in group B and group C(P＜0.05).There was no significant difference in the incidence of hypotension and sinus bradycardia between group B and group C(P＞0.05).There was no significant difference in the incidence of nausea,vomiting and dizziness among the three groups(P＞0.05).Conclusion The analgesic effect of 0.6 μg/(kg·h)dose dexmedetomidine com-bined with sufentanil can effectively reduce the body's stress response and immune suppression,improve sleep quality,but with a greater incidence of intraoperative hypotension and bradycardia.

Cognitive dysfunction has emerged as a significant health challenge in aging societies, among which Alzheimer's disease(AD)and related dementia have become one of the leading causes of death among the elderly.These diseases are characterized by insidious onset and progressive deterioration, often reaching irreversible advanced stages at initial diagnosis, making early detection and prevention imperative.As the frontline of public health management, communities bear the responsibility for screening and managing major chronic diseases.However, community-based cognitive screening in China still remains in its nascent stages, lacking systematic management and prevention guidelines.This guideline, established under a multidisciplinary collaborative framework and adhering to evidence-based medicine principles, systematically reviews and analyzes the latest clinical evidence worldwide.Utilizing the GRADE(Grading of Recommendations Assessment, Development and Evaluation)system to evaluate evidence quality and following the RIGHT(Reporting Items for Practice Guidelines in Healthcare)statement for standardized guideline development, it ultimately presents 17 recommendations through three rounds of Delphi expert consultations.The core recommendations of this guideline is mainly to use digital cognitive scales to conduct large-scale community cognitive screening for the active individuals aged 60 or above.Stratification and staging should be performed based on screening results, and digital cognitive files with quantified risk factor grading should be established, followed by the formulation of personalized artificial intelligence(AI)prevention and control programs.This guide is the first in China and internationally to propose a quantitative grading system for low, medium, and high-risk factors associated with AD and vascular dementia(VD). It aims to provide standardized principles and practical pathways to advance China's ambitious goals: achieving ≥80% public awareness of dementia prevention knowledge, ≥80% cognitive screening rate among the elderly, ≥80% intervention guidance rate for at-risk populations, and ≥50% medical consultation rate for suspected cognitive impairment cases.

Objective To explore the correlation between the ratio of free triiodothyronine/free thyroxine(FT3/FT4)and the early-phase insulin secretion index(ΔI30/ΔG30)in type 2 diabetes mellitus(T2DM)patients with normal thyroid function.Methods 200 patients with T2DM with normal thyroid function in Hebei General Hospital from September 2019 to June 2021 were selected and divided into the Q1 group with FT3/FT4≤0.26(n=67),the Q2 group with 0.27≤FT3/FT4≤0.29(n=67),and the Q3 group with FT3/FT4≥0.30(n=66)according to the tertiles of the FT3/FT4.The general data,biochemical indicators and islet functions of the three groups were compared,and the relationship between the FT3/FT4 ratio and the ΔI30/ΔG30 as well as the islet β cell function was analyzed.Results The fasting insulin(FIns),2 h postprandial insulin(2 hIns),homeostatic model assessment of islet β cell(HOMA-β)and area under the curve of insulin(AUCI)in Q3 group were higher than those in Q1 and Q2 groups(P<0.05),2 h postprandial blood glucose(2 hPG)in Q3 group was lower than those in Q1 and Q2 groups(P<0.05).Systolic blood pressure in Q2 group was higher than those in Q1 group(P<0.05).Compared with Q1 group,diastolic blood pressure,body mass index(BMI),alanine aminotransferase(ALT),fasting C-peptide(FC-P),area under curve of C-P(AUCC),2 h postprandial C-peptide(2 hC-P)and ΔI30/ΔG30 in Q3 group were significantly higher(P<0.05),and HbA1c was significantly lower(P<0.05).Spearman correlation analysis showed that Δ I30/Δ G30,HOMA-β,AUCI,AUCC and HOMA-IR were positively correlated with BMI,ALT,FC-P,2 hC-P,FIns,2 hIns and FT3/FT4(P<0.05),it was negatively correlated with HbA1c and 2 hPG(P<0.05).Linear regression analysis showed that ΔI30/ΔG30,HOMA-β,AUCI and AUCC were the influencing factors of FT3/FT4 after adjusting for confounding factors.Conclusions ΔI30/ΔG30,HOMA-β,AUCI and AUCC are the influencing factors of FT3/FT4 in T2DM patients with normal thyroid function,suggesting that FT3/FT4 is higher in patients with better islet β cell secretion function.

Objective To investigate the predictive capacity of the Triglyceride-Glucose(TyG)index and the Triglyceride-Glucose-Body Mass Index(TyG-BMI)for the development of hyperuricemia(HUA)in a health examination population,and to identify suitable indicators as risk assessment tools for HUA.Methods This study ultimately included 12 004 participants from a health examination cohort.According to SUA levels,the partici-pants were categorized into a normal group(n=9 952)and a hyperuricemia(HUA)group(n=2 052).The TyG index and TyG-BMI index were calculated,and participants were further stratified into four groups(Q1—Q4)based on the quartiles of these indices.Binary logistic regression analysis was performed to assess the association between TyG,TyG-BMI,and HUA.The predictive value of TyG,TyG-BMI,and their combination for HUA was evaluated using Receiver Operating Characteristic(ROC)curves and the Area Under the Curve(AUC).Subgroup analyses were carried out by gender and age.Results The TyG and TyG-BMI indices were significantly elevated in the HUA group compared to the normal group.The prevalence of HUA was markedly higher in the TyG-Q4 and TyG-BMI-Q4 groups than in the other three corresponding quartile groups.Binary logistic regression analysis revealed a positive association between TyG,TyG-BMI levels,and the risk of HUA.The AUC values for predicting HUA using TyG,TyG-BMI,and their combination were 0.700,0.747,and 0.822,respectively.Specifically,for males,the AUC values were 0.641,0.674,and 0.709,respectively,whereas for females,they were 0.742,0.776,and 0.829,respectively.Among individuals younger than 60 years old,the AUC values were 0.716,0.759,and 0.835,respectively,while for those aged 60 years or older,the values were 0.614,0.645,and 0.731,respectively.Conclusions TyG and TyG-BMI are significantly associated with the risk of HUA.Specifically,TyG-BMI demon-strates superior predictive performance compared to TyG alone.Moreover,the combination of TyG and TyG-BMI further improves predictive accuracy,particularly among female and middle-aged or younger populations.

Objective To explore the correlation between cardiac remodeling and the occurrence of contrast-associated acute kidney injury(CA-AKI)assessed by echocardiography.Methods A retrospective analysis was conducted on the clinical data of 100 patients with coronary artery disease(CAD)who underwent coronary angiography(CAG)and percutaneous coronary intervention(PCI)from March 2021 to March 2024.The patients were divided into CA-AKI group and non-CA-AKI group according to whether CA-AKI occurred.Baseline data and echocardiographic parameters,inclu-ding left ventricular end-diastolic internal diameter index(LVIDDI),left ventricular end-systolic in-ternal diameter index(LVIDSI),and left ventricular mass index(LVMI),were collected and com-pared between the two groups.Logistic regression analysis was used to screen for independent influen-cing factors of CA-AKI occurrence.Results The level of N-terminal pro-B-type natriuretic peptide(NT-proBNP)in the CA-AKI group was higher than that in the non-CA-AKI group,and the difference was statistically significant(P＜0.001).Compared with the non-CA-AKI group,the CA-AKI group had higher levels of C-reactive protein and glycosylated hemoglobin(HbA1c),as well as a higher proportion of patients with diabetes and anemia,and the differences were statistically significant(P＜0.05).Echocardiographic data showed that LVMI,LVIDDI,and LVIDSI in the CA-AKI group were all higher than those in the non-CA-AKI group,and the differences were statistically sig-nificant(t=2.057,3.429,2.975;P＜0.05).The left ventricular ejection fraction(LVEF)level in the CA-AKI group was lower than that in the non-CA-AKI group,and the difference was statisti-cally significant(t=3.005,P=0.003).Univariate Logistic regression analysis showed that diabe-tes,anemia,inflammation,NT-proBNP,HbA1c,LVMI,LVIDDI,LVIDSI,LVEF,ventricular hy-pertrophy,and ventricular dilation were significantly associated with the occurrence of CA-AKI(P＜0.05).Multivariate Logistic regression analysis results showed that LVMI(OR=3.81;95％CI,1.04 to 8.50;P=0.045),LVIDDI(OR=4.21;95％CI,2.02 to 6.08;P＜0.001),LVIDSI(OR=1.61;95％CI,1.27 to 2.03;P=0.024),ventricular hypertrophy(OR=3.42;95％CI,1.83 to 4.44;P=0.001),and ventricular dilation(OR=2.93;95％CI,1.43 to 3.74;P=0.033)were independent influencing factors for the occurrence of CA-AKI.Conclusion Cardiac remodeling is significantly correlated with the risk of CA-AKI in CAD patients.Clinicians should take protective measures timely for patients with abnormal cardiac structure to prevent the occurrence of CA-AKI.