AIM: To investigate the value of maximum standardized uptake value(SUVmax), extraocular muscle(EOM)diameter, and thyroid stimulating hormone receptor antibody(TRAb)in evaluating inflammatory activity in thyroid-associated ophthalmopathy(TAO).METHODS: TAO patients underwent orbital 99mTc-DTPA SPECT/CT imaging at the Affiliated Hospital of Panzhihua University between January 2023 and December 2024 were retrospectively enrolled. According to the clinical activity score(CAS), patients were classified into an active group and an inactive group. SUVmax and EOM were independently measured by three nuclear medicine physicians, and the mean values were used for analysis. Serum TRAb levels from TAO patients were measured using a fully automated electrochemiluminescence immunoassay analyzer. Nonparametric tests were used to compare differences between the two groups. Spearman correlation analysis was performed to assess the correlations of CAS with SUVmax, EOM, and TRAb. Using CAS as the reference standard, receiver operating characteristic(ROC)curves were plotted to evaluate the diagnostic performance of SUVmax, EOM, and TRAb, as well as their combination. Intraclass correlation coefficient(ICC)was used for reliability analysis to evaluate the consistency of SUVmax and EOM among the 3 measurers.RESULTS: A total of 99 patients(198 eyes)with TAO were enrolled in this study, including 38 males and 61 females, aged 16-74(46.92±11.84)y. The active group comprised 46 patients(92 eyes), aged 16-71(48.40±12.02)y, with 25 males and 21 females. The inactive group included 53 patients(106 eyes), aged 17-74(45.46±11.59)y, consisting of 13 males and 40 females. There were no statistically significant differences between the two groups in terms of gender and age(P>0.05). Statistically significant differences were observed in SUVmax, EOM, and TRAb. Compared with the inactive group, the active group showed higher SUVmax, EOM, and TRAb levels(all P<0.01). Correlation analysis showed that CAS was positively correlated with SUVmax, EOM, and TRAb(r=0.734, 0.622, and 0.404, respectively, all P<0.01). ROC curves were plotted using CAS as the reference standard, and the AUCs for SUVmax, EOM, TRAb, and their combined diagnosis were 0.874, 0.797, 0.715, and 0.892, respectively. The ICC of SUVmax and EOM were 0.925(95%CI: 0.901-0.948, P<0.001)and 0.943(95%CI: 0.907-0.964, P<0.001)respectively.CONCLUSION: Beyond CAS, there is a need to identify objective imaging and serological biomarkers. Measurements of SUVmax and EOM provide visualized and quantifiable tools for assessing TAO activity, and their combination with TRAb can further improve the accuracy of activity assessment.

ObjectiveBased on ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS^E） technique， we identified qualitatively the metabolites of aristolochic acid（AAs） in rat in order to analyze the metabolic differences between water extract of Aristolochiae fructus（AFE） and Aristolochic acid Ⅰ（AAⅠ）. MethodSD rats were selected and administered AFE（110 g·kg^-1·d^-1） or AAⅠ（5 mg·kg^-1·d^-1） by oral for 5 days， respectively. Serum， urine and feces were collected after administration. Through sample pretreatment， ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm） was used with the mobile phase of 0.01% formic acid methanol（A）-0.01% formic acid water（B， containing 5 mmol·L^-1 ammonium acetate） for gradient elution（0-1 min， 10%B； 1-7 min， 10%-75%B； 7-7.2 min， 75%-95%B； 7.2-10.2 min， 95%B； 10.2-10.3 min， 95%-10%B； 10.3-12 min， 10%B） at a flow rate of 0.3 mL·min^-1. Positive ion mode of electrospray ionization（ESI⁺） was performed in the scanning range of m/z 100-1 200. In combination with UNIFI 1.9.4.053 system， the Pathway-MS^E was used to qualitatively analyze and identify the AAs prototype and related metabolites in biological samples（serum， urine and feces）， and to compare the similarities and differences of metabolites in rats in the subacute toxicity test between AFE group and AAⅠ group. ResultCompared with AAⅠ group， 6， 10， 13 common metabolites and 14， 20， 30 unique metabolites were identified in biological samples（serum， urine and feces） of AFE group， respectively. Moreover， the main AAs components always followed the metabolic processes of demethylation， nitrate reduction and conjugation. Compared with common metabolites in AAⅠ group， prototype components of AAⅠ in serum and most metabolic derivatives of AAⅠ［AAⅠa， aristolochic lactam Ⅰ（ALⅠ）a， 7-OHALⅠ and its conjugated derivatives］ in biological samples were significantly increased in AFE group（P<0.05， P<0.01）， except that the metabolic amount of ALⅠ in feces of AFE group was remarkably lowed than that of AAⅠ group（P<0.01）. In addition， a variety of special ALⅠ efflux derivatives were also identified in the urine and feces of the AFE group. ConclusionAlthough major AAs components in AFE all show similar metabolic rules as AAⅠ components in vivo， the coexistence of multiple AAs components in Aristolochiae Fructus may affect the metabolism of AAⅠ， and achieve the attenuating effect by increasing the metabolic effection of AAⅠ and ALⅠ.

Objective:To analyze the stability of different internal fixation methods for zygomaticomaxillary complex fracture using finite element biomechanical analysis and to provide a quantitative basis for the option of optimal internal fixation methods.Methods:One patient with zygomaticomaxillary complex ZMC fracture (Zingg B type) was enrolled from the Second Hospital of Dalian Medical University in October 2016.The zygomaticofrontal suture and the inferior orbital rim were fixed during the surgery, and the postoperative function was well recovered with no mouth opening restriction, diplopia or implant displacement, and had a symmetrical facial appearance.The preoperative orbital CT images were collected.The normal craniofacial bones finite element model (FEM/intact) was reconstructed through Mimics, Geomagic, Solidworks and Abaqus softwares based on the non-fractured side and verified.Based on the verified model, the segmentation and assembling was performed according to the fracture location, and the internal fixation models were established according to the methods of surgery, including fixed zygomaticofrontal suture model (FEM/ZFS), fixed inferior orbital rim model(FEM/IOR), fixed zygomaticofrontal suture and inferior orbital rim model (FEM/ZFS+ IOR), fixed ZFS and IOR and zygomaticomaxillary suture model (FEM/ZFS+ IOR+ ZMS). The masseter muscle strength was applied to the model.The stress and displacement were analyzed and the rotation angle of zygoma was calculated to compare the stability of different operative methods.The postoperative model (FEM/post) was established according to the actual operative method and was compared with FEM/ZFS+ IOR.This study protocol was approved by the Ethic Committee of The Second Hospital of Dalian Medical University (2020-33), and written informed consent was obtained from the subject before entering the study.Results:The established FEM/intact had a realistic appearance and good geometric similarity, and the validity and accuracy of model was verified.In the FEM/ZFS+ IOR and FEM/ZFS+ IOR+ ZMS, the maximal stress of the titanium plate was 396 MPa and 426 MPa, respectively, which was lower than the yield strength 483 MPa of pure titanium, and the maximal displacement of the fracture line was 0.10 mm and 0.06 mm, respectively, which was both≤0.1 mm, and the rotation angle of zygoma was both<2°.In the FEM/ZFS and FEM/IOR, the maximal stress of the titanium plate was 730 MPa and 501 MPa, respectively, which was higher than the yield strength of pure titanium; the maximal displacement of fracture line was 0.27 mm and 0.15 mm, respectively, which was >0.1 mm, and the rotation angle of zygoma was <2°.The results of FEM/post were consistent with those of FEM/ZFS+ IOR.Conclusions:The finite element analysis can perform digital analysis and evaluation of the stability of different internal fixation methods before surgery, which is available for the selecting of the optimal fixation methods.Finite element analysis can provide an objective quantitative basis for the precise treatment of zygomaticomaxillary complex fractures.