To evaluate long-term survival and clinical outcomes of patients with knee osteo-arthritis undergoing total knee arthroplasty (TKA) through long-term follow-up.

Objective To investigate whether curcumin(CUR)can reduce chondrocyte inflammation and cartilage degradation in osteo-arthritis(OA)and the underlying mechanisms.Methods A rat model of OA was established.Rats were randomly divided into a Sham,OA,CUR+OA,and deferoxamine(DFO)+OA groups with 10 mice in each group.Chondrocytes from 5-day-old SD rats were divided into the control,interleukin-1β(IL-1β),CUR+IL-1β,and DFO+IL-1β groups.A CCK-8 assay was performed to assess the effects of CUR on cell viability alone or combined with IL-1β.Toluidine blue staining and alcian blue staining were used to observe the morphological changes of IL-1β-induced chondrocytes.The expression of inflammatory response-related proteins(COX-2 and iNOS),extracellular matrix degradation-related proteins(COL2A and MMP13),and p53,SLC7A11,and GPX4 proteins during ferroptosis were detected by Western blotting.The mitochondrial membrane potential was detected by JC-1 staining.Mitochondrial morphology was observed using transmission electron microscopy.Safranine O-fast green/HE staining was performed on cartilage tissues.Immunohistochemical staining was performed to detect COL2A and SLC7A11 expression levels.Results CUR and DFO were found to reduce IL-1β-induced inflammation,cartilage degradation,and ferroptosis,and restore mitochondrial function in chondrocytes.CUR also reversed IL-1β-induced changes in collagen Ⅱ,p53,SLC7A11,GPX4,MMP13,iNOS,and COX-2 levels.In vivo,intra-articular injection of CUR significantly improved cartilage injury in the OA rat model,and the percentages of COL2A-and SLC7A11-positive cells significantly increased in the CUR+OA and DFO+OA groups.Conclusion CUR inhibits ferroptosis and ameliorates cartilage degeneration in OA through p53 signaling pathway.

Objective To observe the value of quantitative CT(QCT)analysis of human body components for predicting microvascular invasion(MVI)status of hepatocellular carcinoma(HCC).Methods Totally 60 HCC patients were retrospectively enrolled and divided into positive group(n=15)and negative group(n=45)based on postoperative pathology findings of MVI or not.Human body composition parameters,including bone mineral density(BMD),subcutaneous fat area(SFA),visceral fat area(VFA),total fat area(TFA)and subcutaneous/visceral fat area ratio(SVR),as well as muscle fat area(MFA),muscle area(MA)and muscle fat infiltration(MFI)of posterior vertebral muscle group based on QCT were compared between groups,and the efficacy of the above parameters for predicting MVI status of HCC was observed.Results SFA,TFA,MFA and MFI were all higher,while MA was lower in positive group than those in negative group(all P＜0.05).The area under the curve(AUC)of SFA,VFA,TFA,MA,MFA and MFI for predicting MVI status of HCC ranged from 0.673 to 0.790(all P＜0.05).TFA and M FI were both independent risk factors of HCC MVI(both P＜0.05),with AUC of 0.790 and 0.759,respectively.Conclusion QCT analysis of human body components was helpful to predicting MVI status of HCC.

Objective To investigate whether curcumin(CUR)can reduce chondrocyte inflammation and cartilage degradation in osteo-arthritis(OA)and the underlying mechanisms.Methods A rat model of OA was established.Rats were randomly divided into a Sham,OA,CUR+OA,and deferoxamine(DFO)+OA groups with 10 mice in each group.Chondrocytes from 5-day-old SD rats were divided into the control,interleukin-1β(IL-1β),CUR+IL-1β,and DFO+IL-1β groups.A CCK-8 assay was performed to assess the effects of CUR on cell viability alone or combined with IL-1β.Toluidine blue staining and alcian blue staining were used to observe the morphological changes of IL-1β-induced chondrocytes.The expression of inflammatory response-related proteins(COX-2 and iNOS),extracellular matrix degradation-related proteins(COL2A and MMP13),and p53,SLC7A11,and GPX4 proteins during ferroptosis were detected by Western blotting.The mitochondrial membrane potential was detected by JC-1 staining.Mitochondrial morphology was observed using transmission electron microscopy.Safranine O-fast green/HE staining was performed on cartilage tissues.Immunohistochemical staining was performed to detect COL2A and SLC7A11 expression levels.Results CUR and DFO were found to reduce IL-1β-induced inflammation,cartilage degradation,and ferroptosis,and restore mitochondrial function in chondrocytes.CUR also reversed IL-1β-induced changes in collagen Ⅱ,p53,SLC7A11,GPX4,MMP13,iNOS,and COX-2 levels.In vivo,intra-articular injection of CUR significantly improved cartilage injury in the OA rat model,and the percentages of COL2A-and SLC7A11-positive cells significantly increased in the CUR+OA and DFO+OA groups.Conclusion CUR inhibits ferroptosis and ameliorates cartilage degeneration in OA through p53 signaling pathway.

Objective To observe the value of quantitative CT(QCT)analysis of human body components for predicting microvascular invasion(MVI)status of hepatocellular carcinoma(HCC).Methods Totally 60 HCC patients were retrospectively enrolled and divided into positive group(n=15)and negative group(n=45)based on postoperative pathology findings of MVI or not.Human body composition parameters,including bone mineral density(BMD),subcutaneous fat area(SFA),visceral fat area(VFA),total fat area(TFA)and subcutaneous/visceral fat area ratio(SVR),as well as muscle fat area(MFA),muscle area(MA)and muscle fat infiltration(MFI)of posterior vertebral muscle group based on QCT were compared between groups,and the efficacy of the above parameters for predicting MVI status of HCC was observed.Results SFA,TFA,MFA and MFI were all higher,while MA was lower in positive group than those in negative group(all P＜0.05).The area under the curve(AUC)of SFA,VFA,TFA,MA,MFA and MFI for predicting MVI status of HCC ranged from 0.673 to 0.790(all P＜0.05).TFA and M FI were both independent risk factors of HCC MVI(both P＜0.05),with AUC of 0.790 and 0.759,respectively.Conclusion QCT analysis of human body components was helpful to predicting MVI status of HCC.

The Xuming Decoction, which is recorded in the "Gu Jin Lu Yan" section of Zhang Zhongjing's Synopsis of the Golden Chamber, is a traditional Chinese medicine formula. Recent literature review and summary of the clinical application research progress have found that this formula is primarily used to treat diseases such as acute cerebral infarction, facial neuritis, multiple sclerosis, Guillain-Barre syndrome, and pulmonary distension. However, different medical practitioners and scholars hold diverse understandings of Xuming Decoction.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective:To analyze the clinical characteristics of adult Chinese patients with syncope.Methods:This is a cross-sectional survey study. Patients with preliminary diagnosis of syncope in the Emergency Department, Geriatrics and Cardiology Outpatient Department, or Syncope Unit of 37 hospitals in 19 provinces, autonomous regions and the Hong Kong Special Administrative Region from June 2018 to March 2021 were included in this study. The clinical features of these patients with syncope were analyzed.Results:A total of 4 950 consecutive patients with syncope were included in this study. The age was (56.3±16.8)years, and 2 604 cases (52.6%) were male. The most common type of syncope was neurally mediated syncope (2 345 (47.4%)), followed by cardiac syncope (1 085 (21.9%)), orthostatic hypotensive syncope (311 (6.3%)), and unexplained syncope accounted for nearly one third (1 155 (23.3%)). Predisposing syncope was more common in patients under 65 years of age(2 066(72.4%) vs. 786(27.6%),χ 2=136.5, P<0.001). Presyncope was more common in patients with neurally mediated syncope (1 972(79.0%) vs.1 908(73.9%), χ 2=17.756, P<0.001). Premonitory symptoms were more common in women(1 837(80.0%) vs. 1 863(73.0%),χ 2=33.432, P<0.001). Presyncope syndrome was more common in patients under 65 years of age (2 482(77.8%) vs. 1 218(73.4%),χ 2=17.523, P=0.001). Cyanosis was more common in ≥65 years old patients (271(18.2%) vs. 369(12.7%), χ 2=23.235, P<0.001). Urinary incontinence was more common in old patients aged ≥65 years(252(15.2%) vs. 345(10.8%), χ 2=19.313, P<0.001). Family history was more common in patients with cardiogenic syncope compared with other types of syncope (264(24.3%) vs. 754(19.5%), χ 2=11.899, P=0.001). Hypertention(1 480(30.5%)), coronary heart disease(1 057(21.4%)), atrial flutter and atrial fibrillation(359(7.2%)), second degree atrioventricular block(236(4.8%)) were common complications of syncope. The proportion of patients with coronary heart disease was significantly higher in cardiac syncope than that of other types of syncope(417(38.4%) vs. 640(16.6%), χ 2=241.376, P<0.001). Other common complications included cerebrovascular diseases (551 (11.1%)) and diabetes mellitus (632(12.8%)). Conclusions:Neurally mediated syncope is the most common syncope in adult Chinese population. Patients with predisposing conditions and premonitory conditions are younger. Presyncope is more common in women. The proportion of family history and coronary heart disease is higher in patients with cardiogenic syncope.

In 2013, Shanghai Medical College of Fudan University restarted the enrollment of the undergraduate students in directional pediatrics. To cultivate medical talents in pediatrics, a serious of educational innovations and practices have been carried out guided by competency training, including training a team of teachers with simulated teaching skills and establishing a teaching platform for simulation teaching. Medical students can practice medicine and gain experience through the risk-free simulated scenarios, that is helpful to enhance their confidence in clinical skills and communications and decrease medical errors in their future careers.

Objective To investigate the association between thyroxine level and nonalcoholic fatty liver disease (NAFLD). Methods A retrospective analysis was performed for 3289 subjects who underwent physical examination in PLA Rocket Force Characteristic Medical Center from July 2015 to April 2019, and according to medical history and thyroid function, they were divided into subclinical hypothyroidism group with 210 subjects and normal thyroid function group with 3079 subjects. According to the results of abdominal color Doppler ultrasound, the normal thyroid function group was divided into NAFLD group with 516 subjects and non-NAFLD group with 2563 subjects; according to body mass index (BMI), the normal thyroid function group was divided into non-obese group (BMI < 25 kg/m 2 ) and obese group (BMI ≥25 kg/m 2 ); according to the age, the normal thyroid function group was divided into elderly group (age ≥60 years) and young and middle-aged group (age < 60 years). The normal thyroid function group was typed based on age and body type. Related data were collected, including sex, age, BMI, blood pressure, waist circumference, fasting blood glucose, uric acid, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, free triiodothyronine, free thyroxine, triiodothyronine, thyroxine, and thyroid stimulating hormone (TSH). The two-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 used for comparison of categorical data between two groups. A multivariate logistic regression analysis was used to investigate risk factors, and the receiver operator characteristic (ROC) curve was used to analyze the cut-off values of related indices in predicting NAFLD. Results The subclinical hypothyroidism group had a higher prevalence rate of NAFLD than the normal thyroid function group (22.38% vs 16.76%, χ 2 =4.380, P =0.036), and in the subclinical hypothyroidism group, the NAFLD patients had a higher level of TSH than the non-NAFLD patients( Z =-1.994, P =0.046). In the subclinical hypothyroidism group, there were no significant differences in thyroid parameters between the NAFLD group and the non-NAFLD group (all P > 0.05); after stratification based on age and body type, in the obese-young and middle-aged subgroup, male sex, low free thyroxine, fasting blood glucose, and triglyceride were independent risk factors for NAFLD (odds ratio=4.729, 0.067, 1.814, and 1.717, P =0.003, 0.010, 0.011, and 0.014). The cut-off values of free thyroxine, fasting blood glucose, and triglyceride were 1.123 ng/dL, 5.15 mmol/L, and 1.02 mmol/L, respectively, in predicting NAFLD, and the area under the ROC curve was 0.832 for combined prediction. Conclusion There is a high prevalence rate of NAFLD in the population with subclinical hypothyroidism, and when thyroid function is within the normal range, low free thyroxine is associated with the onset of NAFLD in the young and middle-aged obese people.