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 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.

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.

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 evaluate the prognosis of Hall technique and traditional performed metal crown (PMC) restoration technique, and to follow up the occlusal changes before and after treatment with Hall technique, providing references for the promotion of Hall technique.Methods:Children who visited the Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University from May 2021 to December 2022 were screened according to the inclusion and exclusion criteria. The therapeutic effects of the two groups were followed up at three time points: 1, 2 and 3 months after operation. The observation results were divided into three outcomes: success (crown in place, no symptoms of pulpitis or periapical periodontitis, no obvious abnormality in occlusion, no need for further treatment), partial failure (crown falling off or crown broken, tooth defect can be repaired, reversible pulpitis) and complete failure (irreversible pulpitis or periapical periodontitis, crown falling off and tooth defect irreparable), and statistical analysis was made. At the same time, the Hall technique group was followed up at five time points as before operation, immediately after operation, 2 weeks after operation, 4 weeks after operation and 8 weeks after operation respectively, in which the occlusion was analyzed by Dental Prescale Ⅱ system. The vertical dimension of occlusion (VDO), overbite and coverage, and canine relationship were recorded and compared. Three-dimensional finite element method was used to model and analyze the stress of the teeth treated with traditional PMC treatment and Hall technique, and the differences between them were compared.Results:Finally, 21 children were included in the Hall technique group, including 12 boys and 9 girls, with age of (5.0±1.4) years. Meanwhile, 22 children including 15 boys and 7 girls were in the traditional PMC group, with age of (5.1±1.3) years. There were 0 cases of complete failure and 0 cases of partial failure both in the Hall technique group and in the traditional PMC group within 1 month. There were 0 cases of complete failure and 1 case of partial failure in the Hall technique group, while 0 cases of complete failure and 0 cases of partial failure in the traditional PMC group within 2 months after operation. Hall technique group failed completely in 1 case and partially in 1 case, while the traditional pre-crown group failed completely in 0 cases and partially in 0 cases 3 months after operation. There was no significant difference in the incidence of primary index/complete failure and secondary index/partial failure between Hall technique group and traditional PMC group (all P>0.05). The occlusal area and occlusal force of children treated with Hall technique decreased immediately after operation compared with those before operation, but gradually recovered to the preoperative level at 2, 4 and 8 weeks after operation. To elaborate, the occlusal area decreased significantly from (14.79±3.55) mm 2 before operation to (10.15±3.17) mm 2 immediately after operation ( P=0.001), and recovered to (15.58±3.39) mm 2 at 8 weeks after operation ( P>0.05 compared with pre-operation). The occlusal force decreased significantly from (436.94±109.59) N before operation to (292.70±96.05) N immediately after operation ( P=0.001), and recovered to (441.86±104.31) N at 8 weeks after operation ( P>0.05 compared with pre-operation). Overbite decreased significantly from (2.54±1.05) mm before operation to (1.80±0.94) mm immediately after operation ( P=0.044) and then recovered to (2.35±1.02) mm ( P>0.05 compared with pre-operation). The coverage changed from (2.41±0.66) mm before operation to (2.27±0.61) mm immediately after operation ( P>0.05) and then recovered to (2.48±0.62) mm ( P>0.05 compared with pre-operation). The canine relationship was (3.12±0.54) mm before operation, and decreased significantly immediately after operation (2.17±0.89) mm ( P=0.001), and recovered to (3.05±0.61) mm after 8 weeks ( P>0.05 compared with pre-operation). In the three-dimensional finite element analysis, the maximum stress of all parts of the affected tooth increased immediately after Hall technique treatment, but with occlusal adjustment, the maximum stress of all parts of the affected tooth decreased, which was similar to that of the traditional metal pre-crown group. The vertical load and oblique load of pre-crown decreased from 180.11 and 496.16 MPa to 108.05 and 297.69 MPa, respectively. The vertical load and oblique load of enamel decreased from 94.83 and 255.94 MPa to 57.21 and 156.44 MPa, respectively. The vertical load and oblique load of dentin decreased from 55.19 and 124.77 MPa to 33.19 and 74.59 MPa, respectively. Conclusions:During the experimental observation period, there is no obvious difference between Hall technique and traditional PMC treatment technology in terms of post-treatment occlusion and clinical prognosis, which supports clinical application.

Objective:To evaluate the effect of arctigenin (ARG) on cognitive dysfunction induced by sevoflurane anesthesia in aged rats and the role of autophagy-mediated pyroptosis.Methods:Fifty SPF male Sprague-Dawley rats, aged 18-20 months, weighing 550-600 g, were divided into 5 groups ( n=10 each) using a random number table method: control group (C group), sevoflurane anesthesia group (Sev group), sevoflurane anesthesia+ ARG group (Sev+ ARG group), sevoflurane anesthesia+ autophagy inducer rapamycin group (Sev+ RAPA group), and sevoflurane anesthesia+ ARG+ autophagy inhibitor 3-methyladenine (3-MA) group (Sev+ ARG+ 3-MA group). Except for group C, the rats in the other groups inhaled 6% sevoflurane for 3 h to establish the cognitive impairment model. At 30 min before anesthesia, ARG 20 mg/kg was intraperitoneally injected in Sev+ ARG group, rapamycin 7.5 mg/kg was intraperitoneally injected in Sev+ RAPA group, and ARG 20 mg/kg (dissolved in dimethyl sulfoxide) was intraperitoneally injected, followed by immediate intraperitoneal injection of 3-MA 1.5 mg/kg in Sev+ ARG+ 3-MA group. The equal volume of dimethyl sulfoxide was intraperitoneally injected in C group and Sev group. The Morris water maze test was conducted to assess the cognitive function at 48 h after the end of administration. After completion of the Morris water maze test, the hippocampal tissue was taken under deep anesthesia for observation of the pathological changes (after HE staining) which were scored and for determination of neuronal pyroptosis (after propidium iodide staining) and expression of neuronal autophagy-related proteins (microtubule-associated protein 1 light chain 3 [LC3], Beclin-1, p62), pyroptosis-related proteins (NOD-like receptor protein 3 [NLRP3], apoptosis-associated speck-like protein containing a CARD [ASC], pro-cysteine aspartate-specific protease 1 [pro-caspase-1], cleaved-caspase-1, gasdermin D [GSDMD], and N-terminal fragment of gasdermin D [GSDMD-N], interleukin-1β [IL-1β] and IL-18). Results:Compared with C group, the escape latency was significantly prolonged, the time of staying at the original platform quadrant was shortened, the number of crossing the original platform was reduced, the hippocampal injury score and neuronal pyroptosis rate were increased, LC3Ⅱ/LC3Ⅰ ratio was decreased, the expression of Beclin-1 was down-regulated, the expression of p62, NLRP3, ASC, IL-1β and IL-18 was up-regulated, and the cleaved-caspase-1/pro-caspase-1 ratio and GSDMD-N/GSDMD ratio were increased in Sev group ( P<0.05). Compared with Sev group, the escape latency was significantly shortened, the time of staying at the original platform quadrant was prolonged, the number of crossing the original platform was increased, the hippocampal injury score and neuronal pyroptosis rate were decreased, LC3Ⅱ/LC3Ⅰ ratio was increased, the expression of Beclin-1 was up-regulated, the expression of p62, NLRP3, ASC, IL-1β and IL-18 was down-regulated, and the cleaved-caspase-1/pro-caspase-1 ratio and GSDMD-N/GSDMD ratio were decreased in Sev+ ARG group and Sev+ RAPA group ( P<0.05). Compared with Sev+ ARG group, the escape latency was significantly prolonged, the time of staying at the original platform quadrant was shortened, the number of crossing the original platform was reduced, the hippocampal injury score and neuronal pyroptosis rate were increased, LC3Ⅱ/LC3Ⅰ ratio was decreased, the expression of Beclin-1 was down-regulated, the expression of p62, NLRP3, ASC, IL-1β and IL-18 was up-regulated, and the cleaved-caspase-1/pro-caspase-1 ratio and GSDMD-N/GSDMD ratio were increased in Sev+ ARG+ 3-MA group ( P<0.05). Conclusions:AGR can alleviate sevoflurane anesthesia-induced cognitive dysfunction in aged rats, and the mechanism is related to reduction of autophagy-mediated cell pyroptosis.

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 explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.