1.Role of endoplasmic reticulum stress-mediated DEAD-box helicase 3 X-linked in a mouse model of concanavalin A-induced immune-mediated liver injury
Zhenzhen PAN ; Ling XU ; Xianru ZHU ; Zihao FAN ; Yaling CAO ; Yinkang MO ; Sai YAN ; Feng REN
Journal of Clinical Hepatology 2026;42(1):134-142
ObjectiveTo investigate the role of DEAD-box helicase 3 X-linked (DDX3X) in immune-mediated liver injury (ILI), and to clarify its mechanism by regulating endoplasmic reticulum stress (ERS)-dependent apoptotic pathway and its association with the clinical progression of hepatitis B. MethodsMice were given injection of concanavalin A (ConA) via the caudal vein to establish a model of ILI, PBS (control group) and different concentrations of ConA were injected into the tail vein of hepatocyte-specific DDX3X-knockout mice (DDX3XΔHep and DDX3X-flox mice (DDX3Xfl/fl), respectively.. The log-rank survival analysis, measurement of the serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and HE staining of liver tissue were performed to assess liver injury, and qRT-PCR and Western Blot were used to measure the mRNA and protein expression levels of glucose-regulated protein 78 (GRP78), CCAAT/enhancer-binding protein homologous protein (CHOP), and DDX3X in liver tissue. Intraperitoneal injection of 4-phenylbutyric acid (4-PBA, 100 mg/kg) was performed to inhibit ERS. Serum samples (n=30) and liver tissue samples (n=6) were collected from healthy controls, chronic hepatitis B (CHB) patients, and hepatitis B virus-associated liver failure (HBV-LF) patients; ELISA was used to measure the serum level of DDX3X, and qRT-PCR/Western Blot was used to analyze the expression of targets in liver tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the control group of mice, the expression of DDX3X in the liver of mice induced by ConA was significantly increased after liver injury (P<0.05), and hepatocyte-specific DDX3X knockout increased the 72-hour survival rate of mice by 55% (compared with 20% in the DDX3Xfl/fl group), with significant reductions in the serum levels of ALT and AST (P<0.000 1) and the expression levels of the ERS markers GRP78 and CHOP (P<0.05). After ERS was inhibited by 4-PBA, there was alleviation of liver injury (with reductions in ALT and AST, P <0.001) and a reduction in DDX3X expression (P<0.01). The analysis of clinical samples showed that the mRNA and protein expression levels of liver DDX3X in CHB patients and HBV-LF patients were significantly higher than those in healthy controls (all P<0.01), and there was a significant increase in the serum level of DDX3X in HBV-LF patients (P<0.000 1). ConclusionDDX3X exacerbates ILI by regulating the ERS-dependent apoptotic pathway (GRP78/CHOP), and its expression is associated with the progression of hepatitis B. Therefore, it can be used as a potential therapeutic target.
2.tRF Prospect: tRNA-derived Fragment Target Prediction Based on Neural Network Learning
Dai-Xi REN ; Jian-Yong YI ; Yong-Zhen MO ; Mei YANG ; Wei XIONG ; Zhao-Yang ZENG ; Lei SHI
Progress in Biochemistry and Biophysics 2025;52(9):2428-2438
ObjectiveTransfer RNA-derived fragments (tRFs) are a recently characterized and rapidly expanding class of small non-coding RNAs, typically ranging from 13 to 50 nucleotides in length. They are derived from mature or precursor tRNA molecules through specific cleavage events and have been implicated in a wide range of cellular processes. Increasing evidence indicates that tRFs play important regulatory roles in gene expression, primarily by interacting with target messenger RNAs (mRNAs) to induce transcript degradation, in a manner partially analogous to microRNAs (miRNAs). However, despite their emerging biological relevance and potential roles in disease mechanisms, there remains a significant lack of computational tools capable of systematically predicting the interaction landscape between tRFs and their target mRNAs. Existing databases often rely on limited interaction features and lack the flexibility to accommodate novel or user-defined tRF sequences. The primary goal of this study was to develop a machine learning based prediction algorithm that enables high-throughput, accurate identification of tRF:mRNA binding events, thereby facilitating the functional analysis of tRF regulatory networks. MethodsWe began by assembling a manually curated dataset of 38 687 experimentally verified tRF:mRNA interaction pairs and extracting seven biologically informed features for each pair: (1) AU content of the binding site, (2) site pairing status, (3) binding region location, (4) number of binding sites per mRNA, (5) length of the longest consecutive complementary stretch, (6) total binding region length, and (7) seed sequence complementarity. Using this dataset and feature set, we trained 4 distinct machine learning classifiers—logistic regression, random forest, decision tree, and a multilayer perceptron (MLP)—to compare their ability to discriminate true interactions from non-interactions. Each model’s performance was evaluated using overall accuracy, receiver operating characteristic (ROC) curves, and the corresponding area under the ROC curve (AUC). The MLP consistently achieved the highest AUC among the four, and was therefore selected as the backbone of our prediction framework, which we named tRF Prospect. For biological validation, we retrieved 3 high-throughput RNA-seq datasets from the gene expression omnibus (GEO) in which individual tRFs were overexpressed: AS-tDR-007333 (GSE184690), tRF-3004b (GSE197091), and tRF-20-S998LO9D (GSE208381). Differential expression analysis of each dataset identified genes downregulated upon tRF overexpression, which we designated as putative targets. We then compared the predictions generated by tRF Prospect against those from three established tools—tRFTar, tRForest, and tRFTarget—by quantifying the number of predicted targets for each tRF and assessing concordance with the experimentally derived gene sets. ResultsThe proposed algorithm achieved high predictive accuracy, with an AUC of 0.934. Functional validation was conducted using transcriptome-wide RNA-seq datasets from cells overexpressing specific tRFs, confirming the model’s ability to accurately predict biologically relevant downregulation of mRNA targets. When benchmarked against established tools such as tRFTar, tRForest, and tRFTarget, tRF Prospect consistently demonstrated superior performance, both in terms of predictive precision and sensitivity, as well as in identifying a higher number of true-positive interactions. Moreover, unlike static databases that are limited to precomputed results, tRF Prospect supports real-time prediction for any user-defined tRF sequence, enhancing its applicability in exploratory and hypothesis-driven research. ConclusionThis study introduces tRF Prospect as a powerful and flexible computational tool for investigating tRF:mRNA interactions. By leveraging the predictive strength of deep learning and incorporating a broad spectrum of interaction-relevant features, it addresses key limitations of existing platforms. Specifically, tRF Prospect: (1) expands the range of detectable tRF and target types; (2) improves prediction accuracy through multilayer perceptron model; and (3) allows for dynamic, user-driven analysis beyond database constraints. Although the current version emphasizes miRNA-like repression mechanisms and faces challenges in accurately capturing 5'UTR-associated binding events, it nonetheless provides a critical foundation for future studies aiming to unravel the complex roles of tRFs in gene regulation, cellular function, and disease pathogenesis.
3.A novel arterial coupler with non-return snap-fit connection approach optimized arterial end-to-end anastomotic technique: An experimental study.
Hong-Bo GUO ; Mo-Fei WANG ; Ren-Qi YIN ; Kang-Kang ZHI
Chinese Journal of Traumatology 2025;28(1):13-21
PURPOSE:
Hand-sewn anastomosis as the gold standard of vascular anastomosis cannot fully meet the requirements of vascular anastomosis in speed and quality. Various vascular couplers have been developed to ameliorate this situation. Most of them are mainly used for venous anastomosis rather than arterial anastomosis. Although it is generally acknowledged that in almost all operations involving vascular reconstruction, it is the arteries that need to be anastomosed faster and more accurately and not the veins. A dedicated device is needed for creating arterial anastomosis in an easy, timesaving, less damaging but reliable procedure. Therefore, we plan to develop a novel arterial coupler device and test pre-clinical safety and effectiveness.
METHODS:
In this cohort study, the rationality of this novel arterial coupler was preliminarily tested by finite element analysis before it was manufactured. Several factors restrict the use of vascular couplers in arterial anastomosis, such as arterial eversion, fixation, etc. The manufactured arterial couplers underwent in vitro and in vivo experiments. In vitro, isolated arteries of beagles were anastomosed with the assistance of an arterial coupler, and the anastomosed arteries were evaluated through anti-traction tests. In animal experiments, the bilateral femoral arteries of 5 beagles served as a control group. After dissection, the femoral artery on one side was randomly selected to be anastomosed with a quick arterial coupler (QAC) (QAC group), and the femoral artery on the other side was anastomosed by the same person using an end-to-end suture technique with a 6-0 Prolene suture (suture group). The bilateral femoral arteries of 5 beagles were used for coupler-assisted anastomosis and hand-sewn anastomosis in vivo, respectively. Success rate, blood loss, anastomotic time, clamp time, total operation time, and patency rate were recorded. The patency of anastomosed arteries was assessed using vascular Doppler ultrasound, electromagnetic flowmeter, and pathological examination (6 weeks after surgery).
RESULTS:
As a novel arterial coupler, QAC was successfully designed and manufactured by using poly lactic-co-glycolic acid raw materials and 3-dimensions printing technology. Its rationality was preliminarily tested through finite element analysis and related mechanical analysis methods. The isolated arteries were successfully anastomosed with the assistance of QAC in vitro testing, which showed good anti-traction properties. In animal studies, QAC-assisted arterial anastomosis has superior profiles compared to hand-sewn anastomosis in anastomotic time (7.80 ± 1.41 vs. 16.38 ± 1.04 min), clamp time (8.80 ± 1.41 vs. 14.14 ± 1.57 min), and total operation time (46.64 ± 2.38 vs. 51.96 ± 3.65 min). The results of electromagnetic flowmeter, vascular Doppler ultrasound, and pathological examination showed that QAC-assisted anastomotic arteries were superior to hand-sewn arteries in terms of postoperative blood flow (16.86 ± 3.93 vs. 10.36 ± 0.92 mL/min) and vascular patency in 6 weeks after surgery.
CONCLUSION
QAC is a well-designed and easily maneuverable device specialized for end-to-end arterial anastomosis. Application of this device may decrease thermal ischemia time and improve the patency of anastomotic arteries, thus, improving outcomes.
Animals
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Anastomosis, Surgical/instrumentation*
;
Dogs
;
Femoral Artery/surgery*
;
Vascular Surgical Procedures/instrumentation*
;
Finite Element Analysis
4.Novel biallelic MCMDC2 variants were associated with meiotic arrest and nonobstructive azoospermia.
Hao-Wei BAI ; Na LI ; Yu-Xiang ZHANG ; Jia-Qiang LUO ; Ru-Hui TIAN ; Peng LI ; Yu-Hua HUANG ; Fu-Rong BAI ; Cun-Zhong DENG ; Fu-Jun ZHAO ; Ren MO ; Ning CHI ; Yu-Chuan ZHOU ; Zheng LI ; Chen-Cheng YAO ; Er-Lei ZHI
Asian Journal of Andrology 2025;27(2):268-275
Nonobstructive azoospermia (NOA), one of the most severe types of male infertility, etiology often remains unclear in most cases. Therefore, this study aimed to detect four biallelic detrimental variants (0.5%) in the minichromosome maintenance domain containing 2 ( MCMDC2 ) genes in 768 NOA patients by whole-exome sequencing (WES). Hematoxylin and eosin (H&E) demonstrated that MCMDC2 deleterious variants caused meiotic arrest in three patients (c.1360G>T, c.1956G>T, and c.685C>T) and hypospermatogenesis in one patient (c.94G>T), as further confirmed through immunofluorescence (IF) staining. The single-cell RNA sequencing data indicated that MCMDC2 was substantially expressed during spermatogenesis. The variants were confirmed as deleterious and responsible for patient infertility through bioinformatics and in vitro experimental analyses. The results revealed four MCMDC2 variants related to NOA, which contributes to the current perception of the function of MCMDC2 in male fertility and presents new perspectives on the genetic etiology of NOA.
Humans
;
Male
;
Azoospermia/genetics*
;
Meiosis/genetics*
;
Spermatogenesis/genetics*
;
Adult
;
Exome Sequencing
;
Microtubule-Associated Proteins/genetics*
;
Alleles
;
Infertility, Male/genetics*
5.Phenotypic Function of Legionella pneumophila Type I-F CRISPR-Cas.
Ting MO ; Hong Yu REN ; Xian Xian ZHANG ; Yun Wei LU ; Zhong Qiu TENG ; Xue ZHANG ; Lu Peng DAI ; Ling HOU ; Na ZHAO ; Jia HE ; Tian QIN
Biomedical and Environmental Sciences 2025;38(9):1105-1119
OBJECTIVE:
CRISPR-Cas protects bacteria from exogenous DNA invasion and is associated with bacterial biofilm formation and pathogenicity.
METHODS:
We analyzed the type I-F CRISPR-Cas system of Legionella pneumophila WX48, including Cas1, Cas2-Cas3, Csy1, Csy2, Csy3, and Cas6f, along with downstream CRISPR arrays. We explored the effects of the CRISPR-Cas system on the in vitro growth, biofilm-forming ability, and pathogenicity of L. pneumophila through constructing gene deletion mutants.
RESULTS:
The type I-F CRISPR-Cas system did not affect the in vitro growth of wild-type or mutant strains. The biofilm formation and intracellular proliferation of the mutant strains were weaker than those of the wild type owing to the regulation of type IV pili and Dot/Icm type IV secretion systems. In particular, Cas6f deletion strongly inhibited these processes.
CONCLUSION
The type I-F CRISPR-Cas system may reduce biofilm formation and intracellular proliferation in L. pneumophila.
Legionella pneumophila/pathogenicity*
;
CRISPR-Cas Systems
;
Biofilms/growth & development*
;
Phenotype
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Bacterial Proteins/metabolism*
;
Gene Deletion
6.Clinical characteristics and prognosis of fetuses with HNF1B gene variants: an analysis of 52 cases
Lanlan MO ; Saisai YANG ; Shumin REN ; Yaqin HOU ; Huirong SHI ; Qinghua WU
Chinese Journal of Perinatal Medicine 2025;28(4):295-300
Objective:To investigate the clinical characteristics and prognosis of fetuses with HNF1B gene variants. Methods:Fifty-two fetuses with HNF1B gene variants diagnosed by chromosomal copy number variation sequencing and/or whole exome sequencing at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2024 were retrospectively enrolled in this study, including 47 cases of 17q12 microdeletion and five cases of HNF1B point mutations. Prenatal ultrasound features, pregnancy outcomes, and postnatal manifestations were summarized and analyzed using descriptive statistics. Results:The prenatal ultrasound features of the 52 fetuses included enhanced renal parenchymal echo in 43 cases (82.7%), renal cysts in 15 cases (28.8%), enlarged kidney volume in 14 cases (26.9%), and pyelectasis in 13 cases (25.0%). Parental verification was completed for 35 cases, with 71.4% (25/35) being de novo mutations and 28.6% (10/35) inherited from either parent. Apart from eight cases with unknown pregnancy outcome (six cases were lost to follow-up, two cases refused to be followed up), the other 44 cases were successfully followed up, among which 68.2% (30/44) terminated the pregnancies and 31.8% (14/44) continued, resulting in live births. Prenatal ultrasound indicated renal abnormalities in all 14 live births, while postnatal follow-up showed seven cases with normal kidneys, one with reduced bilateral renal cysts, one with alleviated bilateral pyelectasis, four with unimproved renal structural abnormalities, and one who did not undergo a re-examination. Conclusion:The rate of renal abnormalities diagnosed by prenatal ultrasound in fetuses with HNF1B gene variants is high, and most of the pregnancies are terminated, although the renal sturctural abnormalities may improve after birth.
7.Effect of Honghe Fujie lotion combined with Lactobacillus vaginal capsule on senile vaginitis and its influence on vaginal microenvironment
Mo REN ; Hongwei TAN ; Weiya SHI
Clinical Medicine of China 2025;41(1):8-13
Objective:To explore the therapeutic effect of Honghe Fujie lotion combined with Lactobacillus vaginal capsule on senile vaginitis and its influence on vaginal microenvironment and inflammatory factors in vaginal lavage fluid.Methods:From February 2020 to March 2024 122 patients with senile vaginitis in.first department of gynecology of Northwest Women's and Children's Hospital were retrospectively selected as the study subjects. Among them, 60 patients who adopted Lactobacillus vaginal capsule were included in control group, and 62 patients who received Lactobacillus vaginal capsule combined with Honghe Fujie lotion were enrolled as combined group. The clinical efficacy of the two groups of patients was observed, and the changes of vaginal microenvironment and vaginal lavage fluid inflammatory factors before and after treatment and occurrence of adverse reactions during treatment were compared. The t-test was used for comparing between groups of metric data that conform to normal distribution, the χ2 test was used for comparing between groups of count data, and the rank sum test was used for comparing between groups of rank data. Results:The combined group (95.16%, 59/62) had higher total effective rate after the end of treatment than the control group (85.33%, 50/60) ( χ2=4.48, P=0.034). The levels of tumor necrosis factor- α ((106.22±4.83) ng/L, (109.34±5.52) ng/L), interleukin-6 ((4.19±1.14) ng/L, (4.98±1.42) ng/L) and Toll-like receptor-2 ((5.45±1.02) ng/L, (6.27±1.63) ng/L), vaginal pH value (PH≤4.5: 48 cases, 36 cases) and flora diversity (level 1,2,3,4:51,5,4,2 cases and 32,17,7,4 cases) in combined group and control group after the end of treatment were lower compared with before treatment ((145.27±6.01, 146.19±6.52) ng/L, (13.54±2.21,13.47±2.35) ng/L, (10.21±2.14, 10.34±2.11), (PH≤4.5: 0,0 case, flora diversity level 1,2,3,4:9,26,15,12 cases and 8,24,16,12 cases), the differences were statistically significant (statistical values were t=39.88, t=33.41, t=29.61, t=23.59, t=15.81, t=11.82, χ2=78.32, χ2=51.43, Z=48.77, and Z=21.07, respectively; all P<0.001), and the above-mentioned indicators were lower in combined group , the differences were statistically significant (statistical value s were t=3.33, t=3.39, t=3.34, χ2=4.31, and χ2=10.27, respectively; P value s were 0.001, 0.001, 0.001, 0.038, and 0.001, respectively). There was no statistically significant difference in the vaginal microbiota density between the two groups of patients after treatment compared to before treatment ( χ2=1.01, P=0.314). There was no statistically significant difference in the total incidence of adverse reactions between the two groups of patients during treatment ( χ2=0.18, P=0.675). Conclusion:The combination of Lactobacillus vaginal capsule and Honghe Fujie lotion has an exact efficacy in treating senile vaginitis. It can help to relieve the body's inflammatory response and promote the recovery of normal vaginal microenvironment of patients, and it has good safety. It is worthy of clinical promotion and application.
8.Consensus on informed consent for orthodontic treatment
Yang CAO ; Bing FANG ; Zuolin JIN ; Hong HE ; Yuxing BAI ; Lin WANG ; Haiping LU ; Zhihe ZHAO ; Tianmin XU ; Weiran LI ; Min HU ; Jinlin SONG ; Jun WANG ; Fang JIN ; Ding BAI ; Xianglong HAN ; Yuehua LIU ; Bin YAN ; Jie GUO ; Jiejun SHI ; Yongming LI ; Zhihua LI ; Xiuping WU ; Jiangtian HU ; Linyu XU ; Lin LIU ; Yi LIU ; Yanqin LU ; Wensheng MA ; Shuixue MO ; Liling REN ; Shuxia CUI ; Yongjie FAN ; Jianguang XU ; Lulu XU ; Zhijun ZHENG ; Peijun WANG ; Rui ZOU ; Chufeng LIU ; Lunguo XIA ; Li HU ; Weicai WANG ; Liping WU ; Xiaoxing KOU ; Jiali TAN ; Yuanbo LIU ; Bowen MENG ; Yuantao HAO ; Lili CHEN
Chinese Journal of Stomatology 2025;60(12):1327-1336
This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.
9.Development and validation of risk prediction model for carbapenem-resistant Klebsiella pneumoniae infection
Yinzhu MO ; Xianxiong CHENG ; Cangsang SONG ; Shijie LYU ; Baojun REN ; Zhiwei LI ; Jinying BAO ; Huanzhi YANG
China Pharmacy 2025;36(14):1786-1791
OBJECTIVE To investigate the independent risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection, develop a nomogram prediction model and validate it. METHODS Clinical data of hospitalized patients infected with CRKP between April 2020 and May 2023 at Kunming First People’s Hospital were retrospectively collected and matched 1∶1 with patients infected with carbapenem-susceptible Klebsiella pneumoniae (CSKP) during the same period as the modeling group. Using the same criteria, data from patients hospitalized and infected with CRKP and matched CSKP between June 2023 and June 2024 were collected as the validation group. Univariate analysis, LASSO regression and multivariate Logistic regression were conducted to identify independent risk factors for CRKP infection and to develop a nomogram prediction model. Internal validation of the model was performed using Bootstrap resampling, and external validation was carried out using the data of validation group. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves and calibration plots. RESULTS A total of 530 patients were enrolled, with 372 in the modeling group and 158 in the validation group. Cerebrovascular disease, indwelling gastric tube, mechanical ventilation, exposure to carbapenem antibiotics, and exposure to β-lactamase inhibitor compound agents were identified as independent risk factors for CRKP infection (P<0.05). The nomogram predicting CRKP infection risk achieved an area under ROC of 0.729 and 0.803 in internal and external validations, respectively. Calibration curves indicated a high degree of consistency between predicted and observed probabilities. CONCLUSIONS Cerebrovascular disease, indwelling gastric tube, mechanical ventilation, exposure to carbapenem antibiotics, and exposure to β-lactamase inhibitor compound agent are independent risk factors for CRKP infection. The developed nomogram model for predicting CRKP infection risk demonstrates good predictive performance and can aid in the early identification of patients at high risk for CRKP infection.
10.Clinical and imaging manifestations of posterior tibial tendon dysfunction
Yingli REN ; Jie FAN ; Yunhai MO ; Taoming DU
Journal of Practical Radiology 2025;41(6):1017-1020
Objective To explore the clinical and imaging manifestations of posterior tibial tendon dysfunction(PTTD).Methods A retrospective selection was conducted on 61 patients with clinically diagnosed PTTD.According to the classification criteria of Johnson and Strom,8 patients were classified as stage 1,17 as stage 2,20 as stage 3,and 16 as stage 4.The clinical manifestations and imaging features of patients were summarized at each stage.Results Among the 8 patients with stage 1 PTTD,no abnormalities were found on X-ray examination of the weight-bearing foot,while MRI revealed posterior tibial tendon(PTT)tendinitis in 4 cases(50.0%).For stage 2 patients(n=17),X-ray examination of the weight-bearing foot showed a decrease in the longitudinal arch of the foot in 15 patients(88.2%).MRI mainly revealed PTT degeneration in 12 cases(70.6%),PTT tears in 2 cases(11.8%),and other structural injuries in 5 cases(29.4%).For stages 3-4 patients(n=36),X-ray examination of the weight-bearing foot showed flatfoot in all cases.MRI mainly revealed PTT degeneration in 12 cases(33.3%),PTT tears in 24 cases(66.7%),spring ligament injuries in 33 cases(91.7%),and deltoid ligament injuries in 23 cases(63.9%).Conclusion Patients with stage 1 PTTD often have a normal foot longitudinal arch and may present with PTT tendinitis.Middle-aged females are more commonly affected by advanced PTTD,which is characterized by gradual decrease and collapse of the foot arch,accompanied by varying degrees of PTT degeneration and tears.The spring ligament injuries and deltoid ligament are frequently involved in structural injuries associated with PTTD.

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