Knee osteoarthritis(KOA)is a chronic degenerative joint disease,which poses a major challenge particularly among the elderly population due to its high incidence and high disability.Imaging examination has been used commonly to diagnose KOA.However,it faces imitations in predicting disease progression due to the lack of prior information and constraints in manpower and time.With the rapid evolution of big data and computational technologies,artificial intelligence(AI)is progressively integrating into various healthcare domains.Therefore,the integration of artificial intelligence(AI)into healthcare holds promise for revolutionizing KOA diagnosis and treatment.AI-assisted diagnostic models have demonstrated the potential to automate diagnosis,classify disease severity,and predict disease progression with improved efficiency and accuracy.In addition,these models provide personalized diagnosis and treatment options,as well as accurate disease progression risk assessment.Despite these promising outcomes,challenges such as high costs associated with data annotation and limitations in model generalization capabilities persist.This paper reviews recent advancements in AI applications and summarizes the potential value of utilizing AI applications for KOA.To further enhance the utilization of AI in KOA management to overcome current limitations,future efforts should focus on standardizing clinical sample databases,optimizing AI algorithms,and enhancing external verification sets.

Objective:To investigate the role and analgesic mechanism of ginsenoside Rg1(GRg1)in neuropathic pain in rats.Methods:A total of 30 adult male Sprague-Dawley rats were randomly divided into sham-operation group,spared nerve injury(SNI)group,GRg1 group,GRg1+empty vector group(GRg1+vector group),and GRg1+TLR4 overexpression plasmid group(GRg1+TLR4 group),with 6 rats in each group.The SNI method was used to establish a rat model of neuropathic pain in the latter four groups,and after successful modeling,GRg1 was given by gavage for 14 days,while the plasmid was injected via the caudal vein.The sciatic nerve was exposed for the sham-operation group without any injury manipulation.A mechanical pain threshold detector and a radiation thermal pain threshold detector were used to measure mechanical withdrawal threshold and thermal withdrawal latency on day 1 before surgery and on days 1,3,7,and 14 after surgery.L4-L6 spinal cord tissue samples were collected,and quantitative real-time PCR,Western blot,and indirect immunofluorescence assay were used to measure the mRNA and protein expression levels of GFAP,a marker for astrocyte activation,and Iba-1,a marker for microglial cells;ELISA was used to measure the content of IL-1β,TNF-α,and CXCL1 in spinal cord tissue,and colorimetry was used to mea-sure the content of NO in spinal cord tissue;molecular docking was used to investigate the binding ability and interaction mode between GRg1 and TLR4.Results:GRg1 restored mechanical withdrawal threshold(F=24.67,P=0.000)and thermal withdrawal latency in SNI rats(F=8.058,P=0.034)and downregulated the expression lev-els of GFAP(mRNA:F=37.74,P=0.000;protein:F=98.71,P=0.001)and Iba-1(mRNA:F=62.11,P=0.000;protein:F=187.0,P=0.000)in spinal cord tissues of SNI rats,and it also reduced the levels of IL-1β(F=56.96,P=0.000),TNF-α(F=55.25,P=0.000),CXCL1(F=93.54,P=0.000)and NO(F=30.57,P=0.000)in the spinal cord tissues of SNI rats.The study on mechanisms showed highly stable binding between GRg1 and TLR4,and GRg1 downregulated the expression level of TLR4(mRNA:F=62.66,P=0.000;protein:F=53.52,P=0.000)and the phosphorylation levels of p38(F=300.3,P=0.000)and p65(F=121.6,P=0.000)in spinal cord tis-sues of SNI rats,whereas the overexpression of TLR4 reversed the effect of GRg1(Mechanical Paw Withdrawal Threshold:F=24.67,P=0.000;Thermal Paw Withdrawal Latency:F=8.058,P=0.034;GFAP,mRNA:F=37.74,P=0.009;Protein:F=98.71,P=0.000;Iba-1,mRNA:F=62.11,P=0.006;Protein:F=187.0,P=0.000;IL-1β:F=56.96,P=0.006;TNF-α:F=55.25,P=0.000;CXCL1:F=93.54,P=0.000;NO:F=30.57,P=0.042;TLR4,mRNA:F=62.66,P=0.000;Protein:F=53.52,P=0.000;p38 Phosphorylation Level:F=300.3,P=0.000;p65 Phosphorylation Level:F=121.6,P=0.000).Conclusion:GRg1 may exert an analgesic effect on SNI rats by regulating the TLR4-p38/MAPK-NF-κB signaling pathway and activating the activation of astrocytes and microglial cells in spinal cord tissue.

Objective:To understand the prevalence of frailty and the importance of its influencing factors in adult population in Shaanxi Province.Methods:The data were from Shaanxi baseline survey of natural population cohort study in northwest China during 2018-2019. The frailty index (FI) was constructed to evaluate the frailty status of the population, and XGboost model combined with Shapley method was used to analyze the importance of the sociodemographic and life behavior factors affecting the prevalence of frailty by gender and age.Results:A total of 25 079 subjects were included, in whom 964 (3.8%) had frailty, and there was no significant difference in the overall prevalence of frailty between women (3.9%) and men (3.8%) ( P=0.629), but there was a gender specific difference in the distribution of FI ( P<0.001), and the proportion of the pre-frailty in men was higher than that in women. The prevalence of frailty increased with age ( P<0.001), the prevalence of frailty were 1.3%, 2.5% and 7.8% in young, middle-aged and elderly women, respectively, and 1.9%, 2.7% and 5.5% in young, middle-aged and elderly men, respectively. Sociodemographic characteristics and lifestyle patterns were both influencing factors for the prevalence of frailty, but their importance varied with gender and age. The top five contributing factors were education level, staying up late, annual family income level, sedentary time and marital status in young women, and staying up late, smoking, annual family income level, sedentary time and drinking in young men. The top five contributing factors were education level, annual family income level, passive exposure to smoking, staying up late, and sedentary time in middle-aged women, and annual family income level, education level, sedentary time, staying up late and drinking in middle-aged men. The top five contributing factors were annual family income level, passive exposure to smoking, sedentary time, marital status, and smartphone use in elderly women, and education level, annual family income level, smoking, smartphone use and sedentary time in elderly men. Conclusions:There are gender specific differences in the distribution of FI in Shaanxi. The prevalence of frailty increased with age, but young and middle-aged people also have frailty risk. The prevalence of frailty in young men was mainly related to unhealthy life behaviors, such as staying up late, smoking, sedentary behavior and drinking, while the prevalence of frailty in middle-aged and elderly men and women were more affected by sociodemographic factors, such as education level, economic status and marital status.

Objective:To understand the prevalence of frailty and the importance of its influencing factors in adult population in Shaanxi Province.Methods:The data were from Shaanxi baseline survey of natural population cohort study in northwest China during 2018-2019. The frailty index (FI) was constructed to evaluate the frailty status of the population, and XGboost model combined with Shapley method was used to analyze the importance of the sociodemographic and life behavior factors affecting the prevalence of frailty by gender and age.Results:A total of 25 079 subjects were included, in whom 964 (3.8%) had frailty, and there was no significant difference in the overall prevalence of frailty between women (3.9%) and men (3.8%) ( P=0.629), but there was a gender specific difference in the distribution of FI ( P<0.001), and the proportion of the pre-frailty in men was higher than that in women. The prevalence of frailty increased with age ( P<0.001), the prevalence of frailty were 1.3%, 2.5% and 7.8% in young, middle-aged and elderly women, respectively, and 1.9%, 2.7% and 5.5% in young, middle-aged and elderly men, respectively. Sociodemographic characteristics and lifestyle patterns were both influencing factors for the prevalence of frailty, but their importance varied with gender and age. The top five contributing factors were education level, staying up late, annual family income level, sedentary time and marital status in young women, and staying up late, smoking, annual family income level, sedentary time and drinking in young men. The top five contributing factors were education level, annual family income level, passive exposure to smoking, staying up late, and sedentary time in middle-aged women, and annual family income level, education level, sedentary time, staying up late and drinking in middle-aged men. The top five contributing factors were annual family income level, passive exposure to smoking, sedentary time, marital status, and smartphone use in elderly women, and education level, annual family income level, smoking, smartphone use and sedentary time in elderly men. Conclusions:There are gender specific differences in the distribution of FI in Shaanxi. The prevalence of frailty increased with age, but young and middle-aged people also have frailty risk. The prevalence of frailty in young men was mainly related to unhealthy life behaviors, such as staying up late, smoking, sedentary behavior and drinking, while the prevalence of frailty in middle-aged and elderly men and women were more affected by sociodemographic factors, such as education level, economic status and marital status.

Objective To study the risk factors and prognostic characteristics of pediatric silent lupus nephritis(SLN)with class Ⅲ to V.Methods A retrospective study was conducted to collect clinical data from 30 children diagnosed with SLN at the Department of Pediatrics,Second Xiangya Hospital,Central South University,from May 2007 to April 2023.Based on renal pathological classification,the patients were divided into a class Ⅱ group(12 cases)and a class Ⅲ to Ⅴ group(18 cases).The risk factors for the occurrence of class Ⅲ to Ⅴ SLN were analyzed,and the prognostic characteristics were summarized.Results Among the 30 SLN patients,the median follow-up time was 61.50 months.There were no statistically significant differences in the proportions of patients who discontinued glucocorticoids or achieved low disease activity status,nor in the annual decline rate of estimated glomerular filtration rate(eGFR)between the class Ⅱ and class Ⅲ to V groups(P>0.05).However,three patients in the class Ⅱ group progressed to stage 1 chronic kidney disease(CKD),while eight patients in the class Ⅲ to Ⅴ group reached stage 1 CKD,and four patients reached stage 2 CKD.Among the 26 female SLN patients,serum complement C3 levels in the class Ⅲ to Ⅴ group were lower than those in the class Ⅱ group(P<0.05).Serum C3 levels in SLN patients,as well as in female SLN patients,were negatively correlated with the fluorescence intensity of IgA,IgG,and C3 immune complexes in the kidneys(P<0.05).Additionally,serum C3 levels in female SLN patients were negatively correlated with the renal pathological activity index(P<0.05).Binary logistic regression analysis indicated that being female and having low serum complement C3 levels were risk factors for the occurrence of class Ⅲ to Ⅴ SLN in children(P<0.05).Conclusions Class Ⅲ to Ⅴ SLN is not uncommon among SLN children,and there remains a risk of long-term renal function progression.Being female and having low serum complement C3 levels are identified as risk factors for class Ⅲ to Ⅴ SLN in children.

Objective To compare the effects of different approaches of laparoscopic adrenal tumor resection in treating functional adrenal tumors.Methods Sixty patients with functional adrenal tumors admitted to the Anyang District Hospital from September 2012 to September 2022 were selected as the research subjects.According to different laparoscopic approaches,the patients were divided into a retroperitoneal laparoscopic adrenalectomy group(n=31)and an intraperitoneal laparoscopic adrenalectomy group(n=29).The operation related indexes,stress indexes,immunological indexes,and postoperative complications were compared between the two groups.Results The amount of bleeding and treatment cost in the retroperitoneal laparoscopic adrenalectomy group were lower than those in the intraperitoneal laparoscopic adrenalectomy group,and the operation time,the first meal time after operation,and the hospital stay were shorter than those in the intraperitoneal laparoscopic adrenalectomy group(P＜0.05).There was no statistically significant difference in serum cortisol(Cor),noradrenaline(NE)and adrenaline(E)levels between the two groups before and after operation(P＞0.05).After operation,the levels of serum Cor,NE and E in the two groups were significantly higher than those before operation(P＜0.05).Before operation,there was no statistically significant difference in CD4+level,CD8+level,and CD4+/CD8+ratio between the two groups(P＞0.05).After operation,the CD4+level and CD4+/CD8+ratio in both groups were significantly lower than those before operation,while the CD8+level was significantly higher than that before operation(P＜0.05).After operation,the CD4+level and CD4+/CD8+ratio in the intraperitoneal laparoscopic adrenalectomy group were significantly lower than those in the retroperitoneal laparoscopic adrenalectomy group(P＜0.05);there was no statistically significant difference in the CD8+level between the two groups(P＞0.05).The incidence of postoperative complications in the retroperitoneal laparoscopic adrenalectomy group and the intraperitoneal laparoscopic adrenalectomy group was 6.45％(2/31)and 31.03％(9/29),respectively;it was significantly lower in the retroperitoneal laparoscopic adrenalectomy group(x2=6.048,P＜0.05).Conclusion Laparoscopic adrenalectomy via intraperitoneal approach and retroperitoneal approach is effective in the treatment of functional adrenal tumors.The degree of stress response generated by the two approaches is similar,but the retroperitoneal approach has shorter operation time,less intraoperative bleeding,faster postoperative recovery,less damage to immune function,lower incidence of postoperative complications,and fewer costs.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).

Objective:To explore the efficacy and safety profile of tenofovir alafenamide fumarate (TAF) in the treatment of patients with decompensated hepatitis B cirrhosis.Methods:A two-way cohort study method was used to enroll patients with decompensated hepatitis B cirrhosis who visited four medical centers, including Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine, from April 2021 to April 2024 and were treated with TAF and followed up for 48 weeks. The primary efficacy indicator was hepatitis B virus (HBV) DNA seronegative conversion rate at 48-weeks, and the secondary efficacy indicator was alanine aminotransferase (ALT) return to normal rate at 48-weeks. Relevant safety indicators, adverse drug reactions (ADRs), and clinical adverse outcomes were collected.Results:A total of 74 cases were included. Of these, 52 were males with an average age of (53.14 ± 9.15) years. Twenty-five and thirty-three cases completed 24 and 48 weeks of follow-up, respectively. The HBV DNA negative conversion rate was 96.97% (32/33), which was higher than the baseline of 58.1% (43/74) following 48 weeks of TAF treatment. The ALT return to normal rate was 72.73% (24/33), which was higher than the baseline of 47.30% (35/74); however, the renal function and blood lipid levels did not change significantly compared with the baseline level after completing 48 weeks of treatment (P>0.05). During the follow-up period, one case developed hepatocellular carcinoma, and no other adverse clinical outcomes, such as liver transplantation or death, were reported.Conclusion:TAF has a good efficacy and safety profile in the treatment of patients with decompensated hepatitis B cirrhosis.

Objective:To explore the efficacy and safety profile of tenofovir alafenamide fumarate (TAF) in the treatment of patients with decompensated hepatitis B cirrhosis.Methods:A two-way cohort study method was used to enroll patients with decompensated hepatitis B cirrhosis who visited four medical centers, including Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine, from April 2021 to April 2024 and were treated with TAF and followed up for 48 weeks. The primary efficacy indicator was hepatitis B virus (HBV) DNA seronegative conversion rate at 48-weeks, and the secondary efficacy indicator was alanine aminotransferase (ALT) return to normal rate at 48-weeks. Relevant safety indicators, adverse drug reactions (ADRs), and clinical adverse outcomes were collected.Results:A total of 74 cases were included. Of these, 52 were males with an average age of (53.14 ± 9.15) years. Twenty-five and thirty-three cases completed 24 and 48 weeks of follow-up, respectively. The HBV DNA negative conversion rate was 96.97% (32/33), which was higher than the baseline of 58.1% (43/74) following 48 weeks of TAF treatment. The ALT return to normal rate was 72.73% (24/33), which was higher than the baseline of 47.30% (35/74); however, the renal function and blood lipid levels did not change significantly compared with the baseline level after completing 48 weeks of treatment (P>0.05). During the follow-up period, one case developed hepatocellular carcinoma, and no other adverse clinical outcomes, such as liver transplantation or death, were reported.Conclusion:TAF has a good efficacy and safety profile in the treatment of patients with decompensated hepatitis B cirrhosis.

Objective:To investigate the relationship between triglyceride glucose index (TyG) and body inflammation.Methods:The data were obtained from a baseline survey in population in Xi'an in natural population cohort study in northwest China established in 2018-2019. Based on TG and FPG, TyG/TyG-BMI was constructed to reflect insulin resistance (IR) in the body, and systemic immune-inflammation index (SII) reflecting inflammation in the body was constructed using neutrophil, lymphocyte, and platelet counts. A logistic regression model was used to explore the relationship between the TyG and the SII.Results:A total of 11 491 subjects were included in the analysis. After adjusting for covariates, each unit increase in the TyG increased the risk of high SII by 21% ( OR=1.21, 95% CI:1.12-1.30). The risk of high SII in the group with the TyG in Q4 was 1.34 times higher than that in the group Q1 ( OR=1.34, 95% CI:1.18-1.52). Both sensitivity analysis and subgroup analysis further confirmed the stability of the association between the TyG and the SII. In the population with a BMI ranging from 18.5 to 23.9 kg/m 2, for every unit increase in the TyG as a continuous variable, the risk for high SII increased by 31% ( OR=1.31, 95% CI:1.18-1.45). As a categorical variable, the risk for high SII in the Q4 group was 1.52 times higher than that in the Q1 group ( OR=1.52, 95% CI:1.27-1.83). In a population with BMIs ranging from 24.0 to 27.9 kg/m 2, for every unit increase in the TyG as a continuous variable, the risk for high SII increased by 20% ( OR=1.20, 95% CI:1.07-1.35), and there was no significant difference when it was a categorical variable. Conclusions:The increase in IR is closely related to the development of inflammation in the body, and BMI may regulate their relationship. Early prevention of elevated IR levels before overweight or obesity may have a positive effect on the control of inflammation in the body.