ObjectiveTo evaluate the quality of clinical practice guidelines and expert consensus statements on knee osteoarthritis （KOA） based on the Appraisal of Guidelines for Research & Evaluation Ⅱ （AGREE Ⅱ）， thus providing a new perspective for clinical selection as well as guideline development and updating. MethodsA systematic search was conducted for KOA-related guidelines and consensus statements published from November 1， 2019 to December 31， 2025. The databases and platforms searched included CNKI， VIP， Wanfang Data， PubMed， Web of Science， the National Institute for Health and Care Excellence （NICE）， SinoMed， Yimaitong， and relevant official websites. Two researchers independently screened the literature， and four researchers used AGREE Ⅱ to score the included documents and completed the quality appraisal after reaching a unified understanding. Subgroup analyses were further performed according to developing organization， document type， medical approach， funding status， and region of development， and longitudinal comparisons were conducted by year of publication. ResultsA total of 23 guidelines and consensus statements were included. The standardized scores of the six AGREE Ⅱ domains， from the highest to the lowest， were clarity of presentation ［（70.36±8.13）%］， scope and purpose ［（67.46 ± 11.44）%］， editorial independence ［（64.50±20.01）%］， rigor of development ［（62.24±15.26）%］， stakeholder involvement ［（55.73±10.29）%］， and applicability ［（53.89±13.17）%］. In terms of overall recommendation， 6 documents were rated as grade A and 17 as grade B. Stratified analyses showed that professional organizations scored higher than comprehensive organizations. The overall scores of traditional Chinese medicine/integrative medicine and Western medicine guidelines （or consensus statements） were similar. Guidelines scored higher than consensus statements. The overall scores were similar between documents with reported funding and those without reported funding. International guidelines scored higher than domestic guidelines. Longitudinal comparisons showed that the largest number of documents was published in 2021. The overall scores were higher in 2021—2022， and some domain scores declined in 2023—2024. Overall， the quality of recent guidelines and consensus statements for KOA showed slight fluctuations， without a clear linear trend. ConclusionThe included guidelines and consensus statements for KOA can generally serve as references for clinical practice. However， the quality across domains remains uneven， and stakeholder involvement and applicability are still weak domains. Future guideline development and updating should further improve methodological standardization and transparency in reporting.

AIM: To investigate the effectiveness and safety of defocus incorporated multiple segments(DIMS)on myopia in adolescents, and provide a theoretical basis for clinical application.METHODS:Retrospective study. A total of 560 myopic children(560 eyes)aged 8-13 years who were admitted to our hospital from January 2019 to January 2022 were selected as research subjects, of whom 180 cases(180 eyes)were enrolled in the DIMS group. The orthokeratology(OK lens)group consisted of 182 patients(182 eyes), and the single vision(SV)group consisted of 198 patients(198 eyes). The changes of the spherical equivalent and axial length in the three groups were observed after 1 and 2 a respectively. The myopia degree(group A: spherical equivalent ≥-3.00 D and group B: -6.00 D≤ spherical equivalent <-3.00 D), and age(group Ⅰ: 8-10 years old and group Ⅱ: 11-13 years old)were grouped to further analyze the effect of myopia degree and age on treatment effect.RESULTS: At 1 and 2 a after wearing lenses, the spherical equivalent in the DIMS and SV groups was statistically significant(all P<0.05); there was statistical significance in the axial length among the DIMS, OK and SV groups(F=21.791, 3.576, all P<0.05). At 1 and 2 a after wearing lenses, there was statistical significance in the changes of spherical equivalent in both the DIMS and SV groups of the groups A and B(all P<0.05); and there was statistical significance in axial length growth of the DIMS, OK and SV groups(all P<0.05). At 1 and 2 a after wearing lenses, there was statistical significance in the changes of spherical equivalent in the DIMS and SV groups of the groups Ⅰ and Ⅱ(all P<0.01); in the group Ⅰ, there was statistical significance in the comparison of axial length growth in the DIMS, OK and SV groups(all P<0.05); in the group Ⅱ, there was no statistical significance in the changes of axial length in the DIMS and OK groups. The efficacy of DIMS and OK in the prevention and treatment of myopia was comparable, and the myopia progression was delayed, and the efficacy was enhanced in those older adolescents wearing DIMS.CONCLUSION: Compared with SV lens, DIMS and OK lenses effectively slow down the myopia progression in adolescents. The overall myopia control effect of DIMS is slightly inferior to that of OK lens. However, with the increase of age and the degree of refractive error, the delaying effect of DIMS on myopia progression is enhanced.

Objective:To compare the clinical efficacy of three-in-one procedure versus combined anterior cruciate ligament (ACL) and anterolateral structure (ALS) reconstruction in patients with ACL reconstruction failure.Methods:A total of 32 patients who underwent revision ACL reconstruction from January 2020 to March 2023 were included. The ipsilateral semitendinosus tendon, gracilis tendons, and the anterior half of the ipsilateral peroneus longus tendon, were harvested to constitute the autograft. In patients in whom the ipsilateral semitendinosus and gracilis tendons were unavailable, the bilateral anterior halves of the peroneus longus tendons were utilised. The ACL+ALS group, with bigger transplant graft (diameter >8 mm, n=17; males 13, females 4; mean age 28.29±7.90 years), ACL combined with ALS reconstruction were performed. The three-in-one group ( n=15; males 8, females 7; mean age 29.53±6.73 years) underwent additional iliotibial band (ITB) transposition for grafts with diameter <8 mm (excluding ITB). Operative time, intraoperative blood loss, and graft dimensions were compared. Graft healing was evaluated via postoperative MRI. Knee stability was evaluated via the Lachman test. Lysholm knee score, International Knee Documentation Committee (IKDC) score, knee injury and osteoarthritis outcome score (KOOS), and Tegner activity scale were compared preoperatively, 6-months postoperatively, and 12-months postoperatively, to assess knee function recovery. Results:Surgical parameters revealed that the ACL+ALS group had an operative time of 47.82±9.32 min, blood loss of 29.00±6.99 ml, graft diameter of 8.77±0.69 mm; three-in-one group had an operative time of 57.47±10.06 min, blood loss of 36.33±6.99 ml, graft diameter of 8.53±0.52 mm. Although graft diameter showed no significant intergroup difference ( t=1.065, P>0.05), the three-in-one group showed significantly longer operative times and greater blood loss ( t=2.815, P=0.009; t=2.746, P=0.010). The average follow-up time of the ACL+ALS group was 19.47±5.25 months (range, 12-28 months), whereas the three-in-one group was 20.40±6.50 months (range, 12-32 months). Postoperative MRI showed continuous and homogeneous graft signals in both groups at 6 and 12 months. Lachman test showed negative in 15 cases, grade I in 2 cases in the ACL+ALS group; and negative in 14 cases, grade I in 1 case in the three-in-one group. Both groups exhibited significant improvement from preoperative status ( P<0.001), with no intergroup difference ( P=1.000). Functional scores revealed that both groups showed significant improvement in Lysholm, IKDC, and Tegner scores at 6 and 12 months ( P<0.05 vs. preoperative), with no intergroup differences ( P>0.05). In KOOS subscales, the three-in-one group had significantly lower scores than the ACL+ALS group in pain (88.89±5.75 vs. 94.77±3.79 at 6 months; 89.26±5.93 vs. 96.41±3.22 at 12 months) and sports/recreation (71.33±12.32 vs. 83.53±9.31 at 6 months; 73.67±13.43 vs. 88.24±8.65 at 12 months; P<0.05). Conclusions:When the graft diameter is greater than or equal to 8 mm, both the three-in-one procedure and ACL combined with ALS reconstruction are effective for revision ACL reconstruction. However, patients who underwent three-in-one procedure experienced higher postoperative pain levels.

Objective:To compare the clinical efficacy of three-in-one procedure versus combined anterior cruciate ligament (ACL) and anterolateral structure (ALS) reconstruction in patients with ACL reconstruction failure.Methods:A total of 32 patients who underwent revision ACL reconstruction from January 2020 to March 2023 were included. The ipsilateral semitendinosus tendon, gracilis tendons, and the anterior half of the ipsilateral peroneus longus tendon, were harvested to constitute the autograft. In patients in whom the ipsilateral semitendinosus and gracilis tendons were unavailable, the bilateral anterior halves of the peroneus longus tendons were utilised. The ACL+ALS group, with bigger transplant graft (diameter >8 mm, n=17; males 13, females 4; mean age 28.29±7.90 years), ACL combined with ALS reconstruction were performed. The three-in-one group ( n=15; males 8, females 7; mean age 29.53±6.73 years) underwent additional iliotibial band (ITB) transposition for grafts with diameter <8 mm (excluding ITB). Operative time, intraoperative blood loss, and graft dimensions were compared. Graft healing was evaluated via postoperative MRI. Knee stability was evaluated via the Lachman test. Lysholm knee score, International Knee Documentation Committee (IKDC) score, knee injury and osteoarthritis outcome score (KOOS), and Tegner activity scale were compared preoperatively, 6-months postoperatively, and 12-months postoperatively, to assess knee function recovery. Results:Surgical parameters revealed that the ACL+ALS group had an operative time of 47.82±9.32 min, blood loss of 29.00±6.99 ml, graft diameter of 8.77±0.69 mm; three-in-one group had an operative time of 57.47±10.06 min, blood loss of 36.33±6.99 ml, graft diameter of 8.53±0.52 mm. Although graft diameter showed no significant intergroup difference ( t=1.065, P>0.05), the three-in-one group showed significantly longer operative times and greater blood loss ( t=2.815, P=0.009; t=2.746, P=0.010). The average follow-up time of the ACL+ALS group was 19.47±5.25 months (range, 12-28 months), whereas the three-in-one group was 20.40±6.50 months (range, 12-32 months). Postoperative MRI showed continuous and homogeneous graft signals in both groups at 6 and 12 months. Lachman test showed negative in 15 cases, grade I in 2 cases in the ACL+ALS group; and negative in 14 cases, grade I in 1 case in the three-in-one group. Both groups exhibited significant improvement from preoperative status ( P<0.001), with no intergroup difference ( P=1.000). Functional scores revealed that both groups showed significant improvement in Lysholm, IKDC, and Tegner scores at 6 and 12 months ( P<0.05 vs. preoperative), with no intergroup differences ( P>0.05). In KOOS subscales, the three-in-one group had significantly lower scores than the ACL+ALS group in pain (88.89±5.75 vs. 94.77±3.79 at 6 months; 89.26±5.93 vs. 96.41±3.22 at 12 months) and sports/recreation (71.33±12.32 vs. 83.53±9.31 at 6 months; 73.67±13.43 vs. 88.24±8.65 at 12 months; P<0.05). Conclusions:When the graft diameter is greater than or equal to 8 mm, both the three-in-one procedure and ACL combined with ALS reconstruction are effective for revision ACL reconstruction. However, patients who underwent three-in-one procedure experienced higher postoperative pain levels.

Lung cancer is the cancer type with the highest incidence rate and mortality among malignant tumors in China.Tumor associated macrophages(TAMs)are closely related to the occurrence,development,invasion and metastasis,and treatment tolerance of lung cancer.This article explored the etiology and pathogenesis of lung cancer in TCM,as well as the key role of TAMs in lung cancer.It was found that the local imbalance of yin and yang in TAMs,as well as the overall imbalance of yin and yang in the tumor microenvironment and whole body,were important reasons for the formation and progression of lung cancer.In the progression and sequelae of lung cancer,M1 and M2 type TAMs each plays different roles and has different yin and yang properties.Both of them maintain a constantly developing and changing state of mutual use,opposing constraints,and balance of growth and decline.Based on the yin-yang theory in TCM,according to the progression of lung cancer and the imbalance of yin and yang,rational selection and medication can adjust the phenotype of TAMs,promote the overall balance of yin and yang,and provide reference for the clinical prevention and treatment of lung cancer.

BACKGROUND:Temporomandibular joint osteoarthritis can cause severe pain,which significantly affects the patient's quality of life and psychological health.Studies have found that medical ozone can effectively alleviate pain due to temporomandibular joint osteoarthritis,but its analgesic effect and mechanism are still unclear. OBJECTIVE:To explore the effects of medical ozone on pain relief in temporomandibular joint osteoarthritis and the potential mechanisms. METHODS:Twenty-four Sprague-Dawley rats were randomly divided into four groups(n=6 per group):control group,model group,air group,and medical ozone group.A sodium iodate-induced rat model of temporomandibular joint osteoarthritis was established in all groups except for the control group.After 1 week of modeling,rats in the air group and medical ozone group were injected with clean air and medical ozone,respectively,in the temporomandibular joint.The injection frequency for the air group and medical ozone group was once a week for three times in total.The von Frey mechanized pain measurement technique was used to assess the mechanical pain threshold of the temporomandibular joint in rats before and 28 days after modeling.ELISA was utilized to detect interleukin-1β in both serum and temporomandibular joint fluid at 28 days after modeling.Histopathologic changes of the temporomandibular joint were evaluated through hematoxylin-eosin staining.Additionally,the expression levels of hypoxia-inducible factor 1α and cyclooxygenase 2 in the temporomandibular joint were analyzed using immunohistochemistry. RESULTS AND CONCLUSION:Compared with the control group,the mechanical pain thresholds of the temporomandibular joint in the model group were decreased at 1,3,7,14,21,and 28 days after modeling(P<0.01);and compared with the model and air groups,the mechanical pain thresholds of the temporomandibular joint in the medical ozone group were increased at 28 days after modeling(P<0.01).Compared with the control group,the level of interleukin 1β in the serum and joint fluid of rats in the model group was elevated(P<0.01);compared with the model and air groups,the level of interleukin 1β in the serum and joint fluid of rats in the medical ozone group was decreased(P<0.01).Hematoxylin-eosin staining results showed derangement and degeneration of the cartilage structure in the model group and the air group,while the derangement of the cartilage structure in the medical ozone group was less than that in the model group and the air group.Immunohistochemical staining showed that the expression of hypoxia-inducible factor 1α and cyclooxygenase 2 in the temporomandibular joints of rats in the model group was elevated compared with that in the control group(P<0.01);the expression of hypoxia-inducible factor 1α and cyclooxygenase 2 in the temporomandibular joints of rats in the medical ozone group was decreased compared with that in the model group and the air group(P<0.01,P<0.05).These findings suggest that medical ozone can alleviate the pain caused by osteoarthritis of the temporomandibular joints in Sprague-Dawley rats by reducing the expression of hypoxia-inducible factor 1α,interleukin 1β,and cyclooxygenase 2.

Objective:To prepare hydroxyapatite(HA)coating on polyether ether ketone(PEEK)surface by magnetron sputtering technique and to study its biosafety.Methods:Sulfonated PEEK was used to increase the binding area and HA coating was constructed on it using magnetron sputtering technology.SEM and energy dispersive spectroscopy(EDAX)were used to detect the construction effect.Cell adhesion assay,cytoskeletal fluorescence staining and SEM validation were used to assess cytologrcal safety.In vivo safety tests were conducted in SD rats and golden hamsters.Results:HA coating with gradient morphology was successfully constructed on the PEEK surface using above technique.The coating promoted cell adhesion,extension and proliferation.No systemic toxicity and no sig-nificant influence in HE staining of the main infernal organs samples were observed.The coating alleviated the oral mucosal irritation caused by simple sulfonation to a certain extent.Conclusion:HA coating can be prepared stably with magnetron sputtering technology and can meet the biosafety needs for clinical applications.

Objective To investigate the effect of medical ozone injection therapy on temporomandibular joint(TMJ)osteoarthritis and its pain in SD rats.Methods Fifity-four rats were randomly assigned according to a random number table into three groups:con-trol group,model group,and medical ozone group,with 18 rats in each group.In the control group,only physiological saline was in-jected during modeling;in the model group,only sodium iodoacetate was injected for modeling;in the medical ozone group,after in-jecting sodium iodoacetate into the joint cavity for modeling for one week,medical ozone was then injected into the joint cavity for inter-vention at a frequency of once a week,totaling 5 times.One week(week 2 after modeling),3 weeks(week 4 after modeling),and 5 weeks(week 6 after modeling)after medical ozone injections,6 rats from each group were euthanized.Mechanical withdrawal thresh-old of rats in each group was assessed before euthanasia,and the expression levels of interleukin-1β(IL-1β)in joint fluid of rats in each group were measured after euthanasia.Gross observation and modified Mankin's scoring were performed on TMJ cartilage of rats in each group after stained with Pelletier score and Safranin O-Fast Green.Results During the same time period,compared to the control group,the model group showed a significant decrease in the mechanical pain threshold of the TMJ in rats at 1 week,3 weeks,and 5 weeks(P＜0.01).The expression levels of IL-1β in the TMJ fluid increased(P＜0.01),and the Pelletier score and modified Mankin's score of TMJ cartilage increased(P＜0.01).In comparison to the model group,the medical ozone group exhibited a significant increase in the mechanical pain threshold of the TMJ in rats after 3 weeks and 5 weeks of medical ozone injections(P＜0.01).The expression levels of IL-1β in the TMJ fluid decreased(P＜0.01),and the Pelletier score and modified Mankin's score of TMJ cartilage decreased(P＜0.01).However,there were no statistically significant difference in the measured parameters in the TMJ cavity after 1 week of medical ozone injection(P＞0.05).Within the medical ozone group,compared to the 1-week treatment,the mechanical pain threshold of the TMJ increased(P＜0.01)and the expression levels of IL-1β in the TMJ fluid decreased at 3 weeks and 5 weeks(P＜0.01).However,there was no statistically significant difference in the Pelletier score and modified Mankin's score of TMJ cartilage(P＞0.05)between different treatment duration.Additionally,there were no statistically signif-icant differences in the mechanical pain threshold of the TMJ,expression levels of IL-1β in the TMJ fluid,Pelletier score,and modi-fied Mankin's score of TMJ cartilage between the medical ozone group at 3 weeks and 5 weeks(P＞0.05).Conclusion Medical ozone treatment for more than 3 weeks can improve temporomandibular joint osteoarthritis and its associated pain in rats.

ObjectiveDepression is common in patients with primary biliary cholangitis （PBC）， but the role of depression in disease progression remains unclear. This study aims to investigate the association between depression and treatment response and the impact of depression on liver cirrhosis in PBC patients. MethodsA retrospective analysis was performed for the clinical data of 141 patients with PBC who attended the outpatient service of autoimmune liver diseases in General Hospital of Tianjin Medical University from January 2018 to December 2020 and received standard ursodeoxycholic acid （UDCA） monotherapy for 1 year， and 170 healthy controls， matched for age and sex， who underwent physical examination in Physical Examination Center were enrolled as healthy control group. Patient Health Questionnaire-9 （PHQ-9） was used to evaluate depressive state in the patients with PBC and the healthy controls. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. The binary logistic regression model and the decision tree model were used to analyze the influencing factors for liver cirrhosis in patients with PBC， as well as the influence of depression and the HLA-DRB1 gene on liver cirrhosis. The receiver operating characteristic （ROC） curve， the area under the ROC curve （AUC）， and goodness of fit were used to evaluate model performance. All 13 variables were used to establish a classification and regression tree （CART） model， i.e.， age， sex， PHQ-9 score， the DRB1^*03∶01 gene， and the serum levels of alanine aminotransferase， aspartate aminotransferase， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， total bilirubin， immunoglobulin G， immunoglobulin M （IgM）， C3， and C4. The indications including AUC， sensitivity， and specificity were used to evaluate the performance of CART model in the model cohort. ResultsCompared with the normal control group， the PBC group had a significantly higher proportion of the patients with depression （53.9% vs 15.3%， χ²=57.836， P<0.001）. Compared with the PBC patients without depression， the PBC patients with depression had a significantly poorer response to UDCA treatment （χ²=7.549， P=0.006） and significant increases in the serum levels of ALP （Z=-2.157， P=0.031）， GGT （Z=-2.180， P=0.029）， and IgM （Z=-2.000， P=0.046）. Compared with the PBC patients without depression， the PBC patients carrying the HLA-DRB1^*03∶01 allele had a significant increase in the risk of liver cirrhosis （P<0.001）. The binary logistic regression model analysis showed that PHQ-9 score （OR=1.148， 95%CI： 1.050 — 1.255， P=0.002）， the HLA-DRB1^*03∶01 gene （OR=5.150， 95%CI： 1.362 — 19.478， P=0.016）， age （OR=1.057， 95%CI： 1.009 — 1.106， P=0.018）， and serum ALP level （OR=1.009， 95%CI： 1.001 — 1.017， P=0.020） were independent risk factors for liver cirrhosis in patients with PBC. The decision tree analysis showed that PHQ-9 score ≥3.5 was also a risk factor for liver cirrhosis in PBC patients. ConclusionDepression is associated with poor treatment response in patients with PBC， and it is an independent risk factor for liver cirrhosis in patients with PBC. This study highlights the important clinical significance of the identification and early management of depressive state in patients with PBC.

Depression disorder(DD)is one of the major mental health problems worldwide,and special nutrients such as amino acids,vitamins,fatty acids,probiotics,etc.can affect the emotional state and disease prognosis of DD patients.Amino acids such as tryptophan and S-adenosylmethionine have been shown to improve stress levels in DD patients through various mechanisms,including vitamin B and vitamin C,while unsaturated fatty acids and probiotics have also been shown to have the same effect.This article reviews the mechanisms by which these nutrients improve DD,with the aim of providing new clues for treatment of DD.