Objective To investigate the relationship between the morphology and elasticity of the levator ani muscle(LAM)and stress urinary incontinence(SUI),and to develop a multimodal diagnostic model for SUI based on LAM morphology and elasticity parameters,while evaluating the diagnostic performance of this model.Methods From September 2020 to September 2022,147 female patients with SUI from the Affiliated Hospital of North China University of Science and Technology were enrolled as the SUI group(case group),while 144 women without SUI during the same period were selected as the non-SUI group(control group).Transperineal ultrasonography was conducted to measure the anteroposterior diameter(LH-A1)and transverse diameter(LH-D1)of the levator hiatus at rest,the resting area of the levator hiatus(LA1),as well as the anteroposterior diameter(LH-A2),transverse diameter(LH-D2),and area(LA2)of the levator hiatus during the maximum Valsalva maneuver.Addi-tionally,ultrasonography was used to observe LAM injury(LA-MI)during pelvic muscle contraction.Shear wave elastography(SWE)was also performed transperineally to record the elastic modulus values of the puborectalis muscle at rest(E1)and during pelvic muscle contraction(E3).The differences in ultrasound parameters between the two groups were compared,and a logistic regression model was constructed for multivariate analysis to establish a diagnostic model for SUI.The goodness of fit of the logistic regression model was assessed using the Hosmer-Lemeshow test.The diagnostic performance of individual indicators and the diagnostic model for SUI was evaluated using the receiver operating characteristic(ROC)curve.Finally,the clinical utility of the model was assessed using decision curve analysis.Results There were statistically significant differences in age,BMI,LH-A1,LH-D1,LA1,LH-A2,LH-D2,LA2,LA-MI,E1,and E3 between the two groups(P<0.05).Multivariate logistic regression analysis revealed that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 were significantly associated with SUI(P<0.05).Based on these findings,a diagnostic model for SUI was established:PRESUI=0.261×age+0.904×BMI-4.300×LH-A1+1.166×LA2-2.815×LA-MI+0.587×E1-0.631×E3-1.258.The model demon-strated excellent goodness-of-fit(P=0.983).The ROC curve analysis indicated that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 all exhibited diagnostic efficacy for SUI(AUC>0.500,P<0.05).Notably,the AUC of the constructed diagnostic model for SUI was 0.996(95%CI:0.992～1.000),suggesting that the diagnostic accuracy of the model surpassed that of individual indicators.When the cut-off value of the diagnostic model was set at 0.437,the sensitivity reached 98.0%,and the specificity was 97.2%.Furthermore,the decision curve analysis demon-strated that the diagnostic model provided substantial net clinical benefit within the threshold probability range of 0.1 to 1.0.Conclusions The morphology and elasticity of the LAM are significantly altered in women with SUI.The SWE technique demonstrates potential application value for quantitatively assessing the elasticity of the LAM.Furthermore,the diagnostic model constructed based on age,BMI,LH-A1,LA2,LA-MI,E1,and E3 exhibits high clinical application value.

Objective:To investigate the effect of pristimerin(PT)on doxorubicin(DOX)sensitivity of huamn breast cancer cell MCF-7 by regulating the protein kinase B(AKT)/glycogen synthase kinase-3β(GSK-3β)signaling pathway.Methods:MCF-7 cells were cultured in vitro and used to construct a DOX resistant cell line MCF-7/DOX.MCF-7 cells were separated into the NC group,the L-PT group(2 μmol/L PT),the M-PT group(4 μmol/L PT),the H-PT group(8 μmol/L PT),the H-PT+SC79 group(8 μmol/L PT+10 μmol/L AKT/GSK-3β signaling pathway inhibitor SC79),and the H-PT+LY294002 group(8 μmol/L PT+2.5 μmol/L AKT/GSK-3β signaling pathway activator LY294002).MCF-7/DOX cells were separated into the MCF-7/DOX group(untreated),the DOX group(50 nμmol/L DOX),PT+DOX group(8 μmol/L PT and 50 nμmol/L DOX),the PT+DOX+SC79 group(8 μmol/L PT+50 nμmol/L DOX+10 μmol/L SC79),and the PT+DOX+LY294002 group(8 μmol/L PT+50 nμmol/L DOX+2.5 μmol/L LY294002).MTT assay,plate cloning assay,scratch assay,Transwell assay,and WB assay were applied respectively to determine cell proliferation,colony formation,migration,invasion,and AKT/GSK-3β signaling pathway protein expression in each group.Establish a MCF-7 cell xenograft model in nude mice to observe the effects of PT on tumor growth and the protein expression of the AKT/GSK-3β signaling pathway in the tumor tissues.Results:Compared with the NC group,the proliferation rate,colony formation rate,scratch healing rate,invasive cell count,and the p-AKT,p-GSK-3β protein expressions of MCF-7 cells in the L-PT group,the M-PT group,and the H-PT group all showed a PT concentration dependent decrease(all P<0.05).Compared with the H-PT group,the trend of changes in the above indicators of MCF-7 cells in the H-PT+SC79 group was opposite to the above,while the trend of changes in the above indicators of MCF-7 cells in the PT+DOX+LY294002 group was the same(all P<0.05).There was no significant difference in the proliferation rate,colony formation number,scratch healing rate,invasive cell count,and expressions of p-AKT and p-GSK-3β proteins between the MCF-7/DOX group and the DOX group(all P>0.05).Compared with the MCF-7/DOX group and the DOX group,the PT+DOX group showed a decrease in the above indicators of MCF-7/DOX cells(all P<0.05).Compared with the PT+DOX group,the above indicators in the PT+DOX+SC79 group all increased,while the above indicators in the PT+DOX+LY294002 group all decreased(all P<0.05).Transplant tumor experiment in nude mice showed that compared with those in the control group and the DOX group,the mass and volume of transplant tumors,p-AKT and P-GSK-3β protein expressions in the PT+DOX group all decreased(all P<0.05).Conclusion:PT can inhibit the proliferation,migration,and invasion of BC cells,and enhance their sensitivity to DOX chemotherapy.,Its mechanism is related to the inhibition of the AKT/GSK-3β signaling pathway.

Objective To investigate the relationship between the morphology and elasticity of the levator ani muscle(LAM)and stress urinary incontinence(SUI),and to develop a multimodal diagnostic model for SUI based on LAM morphology and elasticity parameters,while evaluating the diagnostic performance of this model.Methods From September 2020 to September 2022,147 female patients with SUI from the Affiliated Hospital of North China University of Science and Technology were enrolled as the SUI group(case group),while 144 women without SUI during the same period were selected as the non-SUI group(control group).Transperineal ultrasonography was conducted to measure the anteroposterior diameter(LH-A1)and transverse diameter(LH-D1)of the levator hiatus at rest,the resting area of the levator hiatus(LA1),as well as the anteroposterior diameter(LH-A2),transverse diameter(LH-D2),and area(LA2)of the levator hiatus during the maximum Valsalva maneuver.Addi-tionally,ultrasonography was used to observe LAM injury(LA-MI)during pelvic muscle contraction.Shear wave elastography(SWE)was also performed transperineally to record the elastic modulus values of the puborectalis muscle at rest(E1)and during pelvic muscle contraction(E3).The differences in ultrasound parameters between the two groups were compared,and a logistic regression model was constructed for multivariate analysis to establish a diagnostic model for SUI.The goodness of fit of the logistic regression model was assessed using the Hosmer-Lemeshow test.The diagnostic performance of individual indicators and the diagnostic model for SUI was evaluated using the receiver operating characteristic(ROC)curve.Finally,the clinical utility of the model was assessed using decision curve analysis.Results There were statistically significant differences in age,BMI,LH-A1,LH-D1,LA1,LH-A2,LH-D2,LA2,LA-MI,E1,and E3 between the two groups(P<0.05).Multivariate logistic regression analysis revealed that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 were significantly associated with SUI(P<0.05).Based on these findings,a diagnostic model for SUI was established:PRESUI=0.261×age+0.904×BMI-4.300×LH-A1+1.166×LA2-2.815×LA-MI+0.587×E1-0.631×E3-1.258.The model demon-strated excellent goodness-of-fit(P=0.983).The ROC curve analysis indicated that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 all exhibited diagnostic efficacy for SUI(AUC>0.500,P<0.05).Notably,the AUC of the constructed diagnostic model for SUI was 0.996(95%CI:0.992～1.000),suggesting that the diagnostic accuracy of the model surpassed that of individual indicators.When the cut-off value of the diagnostic model was set at 0.437,the sensitivity reached 98.0%,and the specificity was 97.2%.Furthermore,the decision curve analysis demon-strated that the diagnostic model provided substantial net clinical benefit within the threshold probability range of 0.1 to 1.0.Conclusions The morphology and elasticity of the LAM are significantly altered in women with SUI.The SWE technique demonstrates potential application value for quantitatively assessing the elasticity of the LAM.Furthermore,the diagnostic model constructed based on age,BMI,LH-A1,LA2,LA-MI,E1,and E3 exhibits high clinical application value.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the effect of transcranial direct current stimulation(tDCS)in the left posterior sylvia temporal-parietal association area on language function in patients with post-stroke conductive aphasia.Methods The post-stroke aphasia patients admitted to the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were prospectively included from June 2021 to April 2024.A self-cross randomized controlled trial was performed in this study.The patients enrolled were assessed as conductive aphasia by Western aphasia test kit diagnostic criteria.Twelve patients with post-stroke conductive aphasia were completely randomly divided into group A(treatment sequence:stage A—washout period—stage B)and group B(treatment sequence:stage B—washout period—stage A),with 6 cases in each group.Stage A performed true tDCS therapy combined with speech and language training,and stage B performed sham tDCS therapy combined with speech and language training.During washout period,only speech and language training was performed,and each stage was trained for 5 days.The tDCS anode is the stimulation electrode and is placed at the stimulation target.The cathode is the reference electrode and is placed on the right shoulder.The intensity of tDCS was 1.4 mA,the true stimulation was 20 min/time,and the sham stimulation stopped automatically after only 30 s/time,both twice/d,and a total of 10 times treatment were performed.Speech and language training was performed 30 min/time,2 times/d,a total of 10 times treatment.The function of rehearsal and picture naming(training item and non-training item)were examined before and after treatment of stage A and B immediately,and the difference of function scores of rehearsal and picture naming(training item and non-training item)before and after treatment of stage A and B were compared.Results(1)There were no significant differences in gender,age,course of disease and educational level between group A and group B(all P＞0.05).(2)Before and after washout period,there were no statistical significance in functional scores of rehearsal and picture naming(training items and non-training items)in both group A and group B(all P＞0.05).(3)There were no significant differences in functional scores of rehearsal and picture naming(training items and non-training items)between group A and group B before and after washout treatment(all P＞0.05).(4)Compared with the difference before and after treatment of stage B,the function scores difference before and after treatment of stage A in rehearsal function,picture naming(training item)and picture naming(non-training item)were higher([6.9±1.4]scores vs.[2.2±1.0]scores,t=9.604;[6.2±1.2]scores vs.[1.8±1.1]scores,t=9.277;[6.5±1.0]scores vs.[1.5±1.0]scores,t=12.247;all P＜0.01).Conclusions Preliminary analysis suggested that tDCS intervention in the brain tissue of the temporoparietal association area of the left posterior lateral cleft may help improve the rehearsal and picture naming(training and non-training items)ability in conductive aphasia patients after stroke.The sample size of this study is small,and the results need to be further explored.

The gold-standard for bone substitution of large bone defects continues to be autogenous bone graft. Artificial bone substitutes are difficult to replace the autogenous bone grafting due to excessive immune response, fast biodegradation characteristics and inappropriate biocompatibility. Given these drawbacks, osteoimmunology and its advanced functional biomaterials have gained growing attention in recent years. Immune system plays an essential role during bone healing via regulating the shift from inflammatory to anti-inflammation phenotype, and inflammatory cytokines response. The inflammatory reaction mainly include infiltration of immune cells (such as macrophages, neutrophils, T cells, B cells, etc) and release of inflammatory factors (such as IL-1β, IL-6, TNF-α, etc.) at the bone defects, which subsequently affect the step-wised process of bone healing rejuvenation. Hence, advanced bone biomaterials with immunomodulatory properties is of great significance for the treatment of patients with recalcitrant bone defects, especially for delayed healing or non-union. The reciprocal mechanism of immuno-modulated bone healing, however, is not fully understood and more research is required in the future.
Osteogenesis ; Cytokines ; Biocompatible Materials ; Macrophages ; T-Lymphocytes ; Bone Regeneration

Objective:To observe the effects of 0.01% atropine eye drops on ocular biometrics in myopic adolescents.Methods:A prospective cohort study was conducted.Two hundred and nineteen myopic adolescents who visited the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2017 and completed the 1-year follow-up on time were enrolled.The 219 adolescents were divided into a 0.01% atropine+ single-vision spectacles (SV) group (119 cases) wearing single-vision spectacles with one drop of atropine eye drop applied to both eyes once nightly, and a simple SV group (100 cases) wearing SV only.Axial length (AL), corneal power and anterior chamber depth were measured with the IOLMaster.Lens power was calculated using the Bennett-Rabbetts formula.Intraocular pressure was measured by non-contact tonometry.Spherical equivalent (SE) was examined by cycloplegic autorefraction.Total astigmatism and corneal astigmatism were calculated by vector decomposition.The right eye data were analyzed to compare the ocular biometrics changes between the two groups, and multiple linear regression analysis was used to evaluate the influencing factors.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of First Affiliated Hospital of Zhengzhou University (No.2016-35). Written informed consent was obtained from guardians before any medical examination.Results:The SE change and AL elongation 12 months after treatment in 0.01% atropine+ SV group were (-0.47±0.45) D and (0.37±0.22) mm, respectively, which were significantly lower than (-0.70±0.60)D and (0.46±0.35)mm in simple SV group ( t=5.523, 9.651; both at P<0.001). There were significant differences in SE and AL between before and after treatment in both groups (SE: Fgroup=1.556, P=0.015; Ftime=12.538, P=0.002; AL: Fgroup=3.425, P=0.021; Ftime=18.235, P=0.008). The SE and AL at 4, 8 and 12 months after treatment were all increased in comparison with before treatment in both groups, showing statistically significant differences (all at P<0.001). The SE and AL at 8 and 12 months after treatment in 0.01% atropine+ SV group were smaller than in simple SV group, and the differences were statistically significant (all at P<0.001). At 8 and 12 months after treatment, total astigmatism and the anterior chamber depth were increased and the lens power was decreased in comparison with before treatment in both groups, and the differences were statistically significant (all at P<0.05). There was no significant difference in corneal astigmatism, corneal power and intraocular pressure at different time points before and after treatment between the two groups (all at P>0.05). In the multiple linear regression analysis, an equation of Δmyopic SE=-0.012-2.685×ΔAL-1.002×Δcorneal astigmatism-0.656×Δlens power+ 0.477×Δtotal astigmatism+ 0.363×Δanterior chamber depth-0.060×age+ 0.011×sex was used, showing the change of SE was mainly caused by the change of AL ( β=-2.685), then corneal power, lens power, total astigmatism and anterior chamber depth. Conclusions:In adolescents, 0.01% atropine eye drops can effectively retard myopia progression and axial elongation, showing no effect on astigmatism, corneal power, lens power, anterior chamber depth and intraocular pressure.The controlling effect of 0.01% atropine eye drops in the development of myopia is mainly achieved by reducing axial elongation.

ObjectiveTo picture the trajectory of changes in glucose and lipid metabolism among schizophrenic patients in long-term hospitalization. MethodsA total of 109 inpatients of Shenzhen Kangning Hospital from 2014 to 2022， who were diagnosed with schizophrenia based on the International Classification of Diseases， tenth edition （ICD-10） criteria， were recruited as subjects. Real-world follow-up data on longitudinal glucose metabolism （fasting blood glucose， glycosylated hemoglobin， C-peptide） and lipid metabolism （triglycerides， low density lipoprotein， high density lipoprotein， total cholesterol） were observed. The frequency of visit was once a year， with a total of 9 visits over 8 years. ResultsIn terms of glucose metabolism parameters， fasting blood glucose level decreased to 4.87 mmol/L at the 7^th visit， lower than the baseline level （P<0.01）. Glycated hemoglobin level was 6.08% at the 9^th visit， higher than the baseline level （P<0.05）. C-peptide level was 3.14 ng/mL at the 7^th visit， higher than the baseline level （P<0.01）. As for the trajectory of lipid metabolism parameters， high-density lipoprotein level were significantly lower than baseline level at the second visit （P<0.01） and stayed basically stable thereafter. Total cholesterol levels at the last three visits were 4.06， 4.07 and 3.95 mmol/L， respectively， all lower than the baseline level （P<0.01）. ConclusionThe changes of glycolipid metabolism parameters in long-term inpatients with schizophrenia were generally smooth during the 8-year follow-up period.

ObjectiveTo explore the effect of motor imagery (MI) on knee function after unicompartmental knee arthroplasty (UKA). MethodsFrom January to September, 2022, 32 patients underwent UKA for the first time in Xuanwu Hospital were randomly divided into control group (n = 16) and experimental group (n = 16). All the patients accepted routine rehabilitation, and the experimental group accepted MI in addition, until four weeks after discharge. They were assessed with Oxford Knee Score (OKS), Visual Analogue Scale for pain (VAS), range of motion (ROM) of knee, and Timed Up and Go Test (TUGT) before and after treatment. ResultsAll the indexes improved after treatment (|t| > 2.517, P < 0.05), except ROM in the control group; and they improved more in the experimental group than in the control group (F > 7.999, P < 0.01), except the VAS score. ConclusionMI can further improve the knee function after UKA, but do less for pain.

ObjectiveTo study the conceptual framework and methodological system of the International Classification of Functioning, Disability and Health (ICF) in occupational therapy and its systematic implementation in clinical practice. MethodsBased on the ICF theory and the policy documents of the World Federation of Occupational Therapists, the conceptual framework of occupational therapy and the systematic implementation in clinical settings based on the ICF framework were analyzed. ResultsThis study constructed a conceptual framework and approach for occupational therapy based on ICF, and clarified the goals, principles, and implementation methods of integrated occupational therapy interventions in rehabilitation services. The goal of occupational therapy interventions was to improve the individual activity and participation through multidisciplinary and cross-cutting implementation of integrated occupational therapy programs to optimize functioning. Occupational therapy was based on the bio-psycho-social model, adhered to the principles of person-centeredness and functioning orientation, and implemented individualized intervention programs in different context. In clinical practice, it was recommended to follow ICF-based standardized process and systematically use World Health Organization Family International Classifications: functioning and unmet needs analysis using ICHI; functional classification, assessment and coding using ICF; disease classification, diagnosis and coding using ICD; intervention of occupational therapies using ICHI to build a systematic occupational therapy service system. ConclusionAn ICF-based occupational therapy concept and methodological system has been built, a comprehensive clinical occupational therapy implementation model has been established, the goal of activity and participation oriented occupational therapy interventions has been clarified, and the systematic, structured, standardized and refined level of occupational therapy has been enhanced.