Objective: To explore whether digital facial and tongue diagnostic technologies can support the assessment of coronary heart disease (CHD) patients for coronary artery stenosis severity, and examine potential associations between digital tongue diagnosis features and myocardial biomarkers. Methods: The TFDA-1 face and tongue diagnosis instrument and the TDAS analysis system were used to perform intelligent visual examination and analysis of the facial and tongue in CHD patients who attended the Department of Cardiology at Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine between October 2, 2023 and July 31, 2024. Variables were screened using principal component analysis (PCA) and multicollinearity analysis to construct four machine learning models, including random forest, LightGBM, decision tree, and naive Bayes, for the early prediction of coronary artery stenosis severity. Model performance metrics, including sensitivity, specificity, precision, F1 score, accuracy, and the area under the receiver operating characteristic (ROC) curve (AUC), were evaluated. Visual analyses were performed using the SHapley Additive exPlanations (SHAP) interpreter and decision curve analysis. For patients after percutaneous coronary intervention (PCI), a conceptual model linking cardiac biomarkers and tongue diagnosis was constructed using the partial least squares structural equation modeling (PLS-SEM), and its validity was assessed. Results: A total of 459 CHD patients were enrolled and assigned to a PCI group and a non-PCI group (which comprised two subgroups: mild stenosis or less group, moderate stenosis or greater group). For sublingual vein (SV) features, the PCI group had lower SV-a and SV-b than the other groups (P < 0.01 and P < 0.05, respectively). For tongue surface features, the PCI group had significantly higher tongue body (TB)-L, TB-a, and TB-b (P < 0.05, P < 0.01, and P < 0.001, respectively), as well as higher tongue coating (TC)-a and TC-b (P < 0.01 and P < 0.001, respectively). Age, SV-a, SV-b, creatine kinase-myocardial band (CK-MB), CK, TC-a, lip-L, and lip-b were incorporated in the machine learning models. The random forest model performed best, with an AUC of 0.924, an F1 score of 0.839, precision of 0.807, accuracy of 0.864, sensitivity of 0.873, and specificity of 0.839. Decision curve analysis indicated that both LightGBM and random forest had clinical utility. PLS-SEM confirmed the pathway relationships: myocardial biomarkers → TB and myocardial biomarkers → TC (coefficient = – 0.238, t = 2.239, P = 0.025, and coefficient = – 0.270, t = 2.522, P = 0.012, respectively). Conclusion This study developed a noninvasive early warning model for coronary artery stenosis in patients with CHD. It applied PLS-SEM to investigate the association between post-PCI cardiac biomarkers and tongue diagnosis, and validated the proposed association chain. These findings suggest that intelligent traditional Chinese medicine (TCM) visual diagnosis integrated with modern digital technology may support CHD risk assessment and comprehensive health management.

Objective To evaluate the impact of COVID-19 prevention and control measures on the disease burden of upper respiratory infections(URIs)in China.Methods Age-standardized incidence rate,mortality rate,and di-sability-adjusted life-year rate in Global Burden of Disease(GBD)2021 database were used to describe the disease burden and compared before and after the outbreak of COVID-19.The disease burden in 2022-2024 was predicted by the autoregressive integrated moving average model in R 4.4.0 software.Results The disease burden of URIs in China showed a fluctuating downward trend from 1990 to 2021.Age-standardized incidence rate,mortality rate,and disability-adjusted life-year rate showed a downward trend from 2018 to 2019.The age-standardized incidence rate decreased from 137 869.97/100 000(95％UI:121 058.04/100 000-158 137.76/100 000)in 2019 to 137 060.04/100 000(95％UI:120 167.04/100 000-156 888.93/100 000)in 2020.The age-standardized mortality rate were 0.15/100 000(95％UI:0.09/100 000-0.40/100 000)and 0.15/100 000(95％UI:0.09/100 000-0.38/100 000,respectively.The age-standardized disability-adjusted life-year rate decreased from 51.76/100 000(95％UI:32.16/100 000-77.43/100 000)to 51.44/100 000(95％UI:32.19/100 000-76.90/100 000.In 2021,the above-mentioned indicators were higher than those in 2020,but still lower than those in 2019.The au-toregressive integrated moving average model predicted that over the next three years,the age-standardized incidence rate and disability-adjusted life-year rate might show an upward trend,and the age-standardized mortality rate was likely to decline.Conclusion The disease burden of URIs in China shows a downward trend,and declines signifi-cantly after the outbreak of COVID-19.After COVID-19 being categorized as a class B infectious disease managed with class B measures,the age-standardized incidence rate increases,which reflects the effectiveness of the COVID-19 prevention and control measures on reducing the disease burden of URIs.

Objective To investigate the dynamic features of patients with patellofemoral pain(PFP)during running by using support vector machine(SVM)classifier and feature selection method,so as to provide a theoretical support for the prevention and rehabilitation of PFP.Methods An SVM classification model was used to classify healthy individuals(n=13),PFP patients with long-term disease course(n=13),and PFP patients with short-term disease course(n=10)based on their dynamic features during running.The most effective minimum feature set was selected through feature selection method.Results The accuracy rate of the constructed classification model was 83.3%.The minimum feature set selected contained 3 key features.PFP patients with short-term disease course showed a delay in the appearance of impact valleys and active peaks,while PFP patients with long-term disease course showed a lower impact peak-valley slope.Conclusions PFP patients with short-term disease course mainly showed a prolonged shock absorption process and a delayed propulsion action,while PFP patients with long-term disease course showed the most significant feature of having a lower vertical reaction force impact peak-valley slope.These features revealed the specific characteristics of PFP at different stages of the disease,providing a basis for developing individualized rehabilitation programs.

Background and Aims:Endovascular repair of aortic arch diseases poses a major challenge in vascular surgery due to the need to both effectively exclude the lesion and preserve perfusion of supra-aortic branch vessels.The Castor branched aortic covered stent,with its integrated design and ability to maintain left subclavian artery(LSA)patency,offers potential advantages.When combined with the chimney technique for the left common carotid artery(LCCA),it may provide a minimally invasive and feasible solution for patients with insufficient proximal landing zones.This study aims to evaluate the preliminary feasibility and safety of this combined approach and provide clinical reference for the endovascular management of complex aortic arch pathologies.Methods:A retrospective analysis was conducted on 15 patients with aortic arch diseases who underwent treatment with the Castor branched stent-graft combined with LCCA chimney stenting at the Second Xiangya Hospital of Central South University between February 2023 and December 2024.Baseline characteristics,surgical procedures,perioperative complications,and follow-up outcomes were analyzed to assess technical success,complication rates,and branch vessel patency.Results:Among the 15 patients(11 males,average age 63.8 years),primary diagnoses included aortic dissection(33.4%),aortic arch aneurysm(53.3%),and penetrating aortic ulcer(13.3%).The technical success rate was 100%,with no perioperative deaths or major complications.During the follow-up period(4-26 months,mean 12.9 months),no adverse events such as stroke,paralysis,endoleak,or stent migration occurred.The patency rate of both the LCCA and LSA remained 100%.Conclusion:The Castor branched aortic stent-graft combined with LCCA chimney technique appears to be a technically feasible and safe short-term option for treating aortic arch diseases with insufficient proximal landing zones.It may serve as a promising alternative for complex aortic arch repair;however,large-scale,multicenter studies with long-term follow-up are needed to further validate its efficacy and safety.

Objective:To compare the clinical outcomes of thoracic endovascular aortic repair (TEVAR) using self-radiopaque marker guided physician modified fenestration with stent-graft in situ fenestration technology with or without the implantation of branch stents for the treatment of aortic arch diseases.Methods:The clinical data of 653 patients with aortic arch diseases who underwent TEVAR using fenestration from Dec 2015 to Jun 2023 at two vascular surgery centers were retrospectively analyzed.Results:A total of 454 patients received branch stent implantation, while 199 did not. The incidence of non-aortic-related complications within 30 days post-operation was higher in the branch stent implantation group compared to the non-implantation group (8.6% vs. 3.5%, P=0.020). The overall follow-up rate was 93.8%, with median follow-up time of 37 months and 52 months for the branch stent implantation group and non-implantation group, respectively. Kaplan-Meier survival analysis showed no significant statistical difference between the two groups in terms of cumulative all-cause survival ( P=0.223), free from endoleak ( P=0.106), and free from branch artery occlusion ( P=0.130). Conclusions:The implantation of branch stents following in situ fenestration with stent-graft technology in TEVAR did not significantly affect overall survival, endoleak incidence, or branch artery occlusion rates in patients with aortic arch diseases. Therefore, the decision to implant branch stents should be tailored according to the specific pathology and anatomical characteristics of the aortic arch.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective To compare the clinical efficacy of low-molecular-weight heparin anticoagulant drugs in the treatment of venous thrombosis caused by viral pneumonia.Methods The clinical data of 355 patients diagnosed with viral pneumonia patients in the First People's Hospital of Yunnan Province from December 2022 to February 2023 were collected by retrospective analysis.The patients were classified into moderate group(n=1 14),severe group(n=116),and critical group(n=125)based on the severity of viral pneumonia.The changes in coagulation indicators of the patients after treatment with low molecular weight heparin sodium injection,low molecular weight heparin calcium injection,and enoxaparin sodium injection were compared among three groups.Results Compared with before treatment,there was no statistically significant difference in white blood cells count among three groups of patients after treatment(P＞0.05);The hypersensitive C-reactive protein levels of patients in moderate group and critical group decreased(P＜0.05);The levels of D-dimer decreased in severe group and critical group of patients(P＜0.05).After treatment with low-molecular-weight heparin calcium injection,the activated partial thromboplastin and prothrombin time of patients in severe group were shortened compared to before treatment,and the D-dimer levels of patients in severe group and critical group were reduced compared to before treatment,with statistical significance(P＜0.05);After treatment with low-molecular-weight heparin sodium and enoxaparin,only critical group showed a significant decrease in D-dimer levels(P＜0.05).Conclusion Low-molecular-weight heparin calcium injection has a stronger alleviating effect on blood hypercoagulability caused by elevated D-dimer levels than low-molecular-weight heparin sodium and enoxaparin,which is beneficial for relieving patients' hypercoagulability.

BACKGROUND:Although obesity is associated with osteoarthritis,it remains unclear whether visceral adipose tissue has a causal relationship with osteoarthritis. OBJECTIVE:To investigate the causal relationship between visceral adipose tissue and osteoarthritis using two-sample Mendelian randomization methods. METHODS:A total of 221 single nucleotide polymorphisms strongly associated with visceral adipose tissue without linkage disequilibrium were screened from the genome-wide association study (GWAS). Pooled data for osteoarthritis were derived from a large genome-wide association analysis that included up to 826690 subjects (177517 osteoarthritis patients and 649173 controls) from nine different populations. We conducted two-sample Mendelian randomization analyses to assess the causal associations between visceral adipose tissue and early-onset any-site osteoarthritis (before age 45),any-site osteoarthritis,knee osteoarthritis,hip osteoarthritis,knee or hip osteoarthritis,spinal osteoarthritis,thumb osteoarthritis,and finger osteoarthritis. Inverse variance weighting was employed as the primary Mendelian randomization analysis method,with weighted median and MR-Egger methods used for supplementary clarification. RESULTS AND CONCLUSION:Inverse variance weighting results revealed a positive causal effect of visceral adipose tissue on eight types of osteoarthritis:early-onset any-site osteoarthritis[odds ratio (OR)=1.91,95％ confidence interval (CI):1.64-2.24,P=6.04×10-16],any-site osteoarthritis (OR=1.44,95％ CI:1.38-1.49,P=3.65×10-75),knee osteoarthritis (OR=1.87,95％ CI:1.75-2.00,P=1.29×10-79),hip osteoarthritis (OR=1.34,95％ CI:1.24-1.45,P=2.84×10-14),knee or hip osteoarthritis (OR=1.71,95％ CI:1.62-1.80,P=2.97×10-83),spinal osteoarthritis (OR=1.42,95％ CI:1.31-1.54,P=8.89×10-17),thumb osteoarthritis (OR=1.26,95％ CI:1.10-1.44,P=6.21×10-4),and finger osteoarthritis (OR=1.29,95％ CI:1.13-1.49,P=2.68×10-4). Sensitivity analyses showed no heterogeneity,pleiotropy,or outliers in the causal effects of visceral adipose tissue on the eight types of osteoarthritis. These findings indicate that visceral adipose tissue is a risk factor of osteoarthritis,and excessive visceral adipose tissue may increase the risk of osteoarthritis.

Objective To investigate the dynamic features of patients with patellofemoral pain(PFP)during running by using support vector machine(SVM)classifier and feature selection method,so as to provide a theoretical support for the prevention and rehabilitation of PFP.Methods An SVM classification model was used to classify healthy individuals(n=13),PFP patients with long-term disease course(n=13),and PFP patients with short-term disease course(n=10)based on their dynamic features during running.The most effective minimum feature set was selected through feature selection method.Results The accuracy rate of the constructed classification model was 83.3%.The minimum feature set selected contained 3 key features.PFP patients with short-term disease course showed a delay in the appearance of impact valleys and active peaks,while PFP patients with long-term disease course showed a lower impact peak-valley slope.Conclusions PFP patients with short-term disease course mainly showed a prolonged shock absorption process and a delayed propulsion action,while PFP patients with long-term disease course showed the most significant feature of having a lower vertical reaction force impact peak-valley slope.These features revealed the specific characteristics of PFP at different stages of the disease,providing a basis for developing individualized rehabilitation programs.

Objective To investigate the effect of quercetin(QUE)on the Th1/Th2 immune balance in allergic rhinitis(AR)mice via regulating protein tyrosine kinase 2(JAK2)/signal transducer and activator of transcription 3(STAT3)signaling pathway.Method We selected SPF-grade male BALB/c mice and constructed the AR mouse model through sensitization treatment.Seventy-two mice were randomly divided into the model group,the QUE-L group(50 mg/kg QUE by gavage),the QUE-M group(100 mg/kg QUE by gavage),the QUE-H group(200 mg/kg QUE by gavage),and the QUE-H+JAK2/STAT3 pathway activator Coumermycin A1 Group(200 mg/kg QUE by gavage+tail vein injection of 1 mg/kg Coumermycin A1),and normal mice were taken and only treated with 0.9 sodium chloride injection by intraperitoneal injection and nasal drip as the control group.The histopathological morphology of nasal mucosa in each group of mice was detected by HE staining.The levels of interferon-γ(IFN-γ),interleukin-4(IL-4),immunoglobulin E(IgE),interleukin-1β(IL-1β),interleukin-6(IL-6),and interleukin-8(IL-8)in the serum of mice in each group were detected by ELISA.The apoptosis rate of nasal mucosa tissue cells in each group was determined by the TUNEL method,and the protein expressions of JAK2 and STAT3 in the nasal mucosa tissues of mice in each group were detected by Western blot method.Results Compared with the control group,the model group had disorganized nasal mucosal epithelial cells,vasodilation,accompanied by severe inflammatory cell infiltration,presence of obvious pathological changes and decreased serum IFN-γ level(P<0.05).The levels of serum IL-4,IgE,IL-1β,IL-6,IL-8,the apoptosis rate of nasal mucosa tissue cells,and the protein expressions of p-JAK2/JAK2 and p-STAT3/STAT3 increased(P<0.05).The nasal mucosal epithelial cells of mice in the QUE-L group,QUE-M group and QUE-H group were arranged neatly compared with those in the model group.Vasodilation and inflammatory cell infiltration were significantly alleviated,the pathological changes were significantly reduced,and the serum IFN-γ level was increased(P<0.05).The levels of serum IL4,IgE,IL-1β,IL-6,and IL-8,the apoptosis rate of nasal mucosal tissue cells,and the protein expressions of p-JAK2/JAK2 and p-STAT3/STAT3 decreased(P<0.05).Compared with the QUE-H group,the QUE-H+Coumermycin A1 group had aggravated pathological changes,deteriorated inflammation levels and immune imbalance,and increased apoptosis rate of nasal mucosal tissue cells and protein expression in the JAK2/STAT3 pathway(P<0.05).Conclusion QUE may reverse the Th1/Th2 immune imbalance in AR mice by inhibiting the JAK2/STAT3 signaling pathway.