Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

Abstract In recent years, the prevalence of overweight and obesity among children and adolescents has risen rapidly, posing a serious threat to their physical and mental health. To provide scientific, systematic, and standardized weight management guidance for overweight and obese children and adolescents, the study focuses on the core concept of healthy lifestyle intervention, integrates multidisciplinary expert opinions and research findings,and proposes a comprehensive multidisciplinary intervention framework covering scientific exercise intervention, precise nutrition and diet, optimized sleep management, and standardized psychological support. It calls for the establishment of a multi agent collaborative management mechanism led by the government, implemented by families, fostered by schools, initiated by individuals, optimized by communities, reinforced by healthcare, and coordinated by multiple stakeholders. Emphasizing a child and adolescent centered approach, the consensus advocates for comprehensive, multi level, and personalized guidance strategies to promote the internalization and maintenance of a healthy lifestyle. It serves as a reference and provides recommendations for the effective prevention and control of overweight and obesity, and enhancing the health level of children and adolescents.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

In recent years, surgical research has entered the digital era, and the dissemination of medical knowledge has also begun to confront the challenge posed by we media. When we media first emerged, most doctors in public hospitals, who focused on "medicine, education, and research", held a reserved attitude towards it. However, we media has demonstrated remarkable resilience and has continuously evolved to align with the trend of social development. Faced with the future development direction and the existing sore points, how surgeons comprehend and respond to the surging current of the times is a conundrum before us. In this article, the author has sorted out the rise and development of we media, the status of its application in the medical field, and the predicaments faced by medical we media, and has looked forward to its development to broaden the thinking of surgeons for more comprehensive innovation and development.

In recent years, surgical research has entered the digital era, and the dissemination of medical knowledge has also begun to confront the challenge posed by we media. When we media first emerged, most doctors in public hospitals, who focused on "medicine, education, and research", held a reserved attitude towards it. However, we media has demonstrated remarkable resilience and has continuously evolved to align with the trend of social development. Faced with the future development direction and the existing sore points, how surgeons comprehend and respond to the surging current of the times is a conundrum before us. In this article, the author has sorted out the rise and development of we media, the status of its application in the medical field, and the predicaments faced by medical we media, and has looked forward to its development to broaden the thinking of surgeons for more comprehensive innovation and development.

Objective:To explore the clinical and genetic etiology of a Chinese pedigree affected with type 2 Long QT syndrome (LQTS).Methods:A pedigree with type 2 LQTS presented at Fuwai Central China Cardiovascular Hospital on August 23, 2019 was selected as the study subject. Peripheral blood samples were collected from the proband and her parents. Following extraction of genomic DNA, whole exome sequencing (WES) was carried out for the proband, and candidate variant was screened through functional annotation and protein-protein interaction (PPI) analysis. Sanger sequencing was conducted to verify the pathogenicity of candidate variant. This study was approved by Medical Ethics Committee of the Fuwai Central China Cardiovascular Hospital (Ethics No. 2019-15).Results:WES revealed that the proband has harbored a missense variant of the KCNH2 gene, namely c. 1478A>G (p.Tyr493Cys), which was confirmed by Sanger sequencing to have inherited from her father. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was classified as likely pathogenic (PM2_supporting+ PM5+ PP3+ PP4). Conclusion:The KCNH2 gene c. 1478A>G (p.Tyr493Cys) variant probably underlay the type 2 LQTS in this pedigree.

Objective To establish a differential model of phlegm and blood stasis pattern and qi deficiency and blood stasis pattern in stable angina pectoris using radiomics.Methods A total of 91 patients with stable angina pectoris who underwent coronary artery CT angiography in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 2021 to January 2022 were collected,including 47 cases of phlegm and blood stasis pattern and 44 cases of qi deficiency and blood stasis pattern.The patients were divided into train set(64 cases)and test set(27 cases)according to the ratio of 7∶3 by stratified random sampling method.3D-slicer software was used to extract the radiomics features of pericoronary adipose tissue(PCAT)images.Principal component analysis was used to visualize the distribution of radiomics features of pattern of phlegm and blood stasis and pattern of qi deficiency and blood stasis.The least absolute shrinkage and selection operator regression analysis and support vector machine decreasing feature elimination were used for feature selection.The multinomial logistics regression was used for model construction.The receiver operating characteristic(ROC)curve was used to verify the model in the train set and the test set to evaluate the effectiveness of the radiomics features in differentiating phlegm and blood stasis pattern and qi deficiency and blood stasis pattern.Finally,Spearman coefficient was used to analyze the correlation between the differential features and clinical physicochemical data.Results A total of 837 radiomics features were extracted from PCAT images by 3D-slicer software.In the principal component analysis,PC1 and PC2 explained 77.9%and 8.1%of the total variance,respectively,and there was a relatively obvious separation trend between the two pattern groups.After feature screening,7 radiomics features were used to construct the differential model of phlegm and blood stasis pattern and qi deficiency and blood stasis pattern.The area under the ROC curve(AUC)of the differential model was 0.844 in the train set and 0.834 in the test set.Spearman correlation analysis showed that the differential features were significantly correlated with cTnI,neutrophil,triglyceride,total cholesterol,and leukocyte.Conclusion The CT radiomics model based on PCAT has a high discrimination efficiency for stable angina pectoris with phlegm and blood stasis pattern and qi deficiency and blood stasis pattern.

Objective:To investigate the effect of estrogen supplementation therapy on vaginal microbiota and local immunity of postmenopausal high-risk human papillomavirus (HPV) infected women.Methods:A total of 74 postmenopausal women who underwent gynecological examinations or visits at Department of Gynecology, Shanghai Ruijin Rehabilitation Hospital from June 2018 to June 2023 were included in this study. According to HPV test, they were divided into the high-risk HPV-negative women (normal group, n=14) and the high-risk HPV-positive women ( n=60). A randomized controlled clinical trial was designed. Within the high-risk HPV-positive women, they were further randomly assigned by using the random number table method to the experimental group (high-risk HPV-positive women receiving low-dose estrogen therapy orally, n=30) and control group (high-risk HPV-positive women not receiving low-dose estrogen therapy, n=30). Vaginal microbiota composition and expression of inflammatory cytokines in vaginal lavage fluid were measured using fluorescence quantitative PCR and enzyme-linked immunosorbent assay at baseline (week 0), 4th week, and 8th week after enrollment. Results:There were no significant differences in age, menopausal time, body mass index, systolic pressure, diastolic pressure, heart rate, pH value and vaginal cell maturation index (VMI) among the normal group, the experimental group and control group (all P>0.05) which indicated the baseline was comparable. After estrogen treatment, the pH value of the experimental group at 4th and 8th weeks (5.27±0.13, 4.84±0.15) was significantly lower than that at week 0 (6.59±0.17, all P<0.001), while the vaginal cell maturation index (VMI) at 4th and 8th weeks (41.62±2.62, 58.28±2.16) was significantly higher than that at week 0 (25.97±2.60, all P<0.001). The quantitative results showed no significant differences in the abundance of Escherichia coli among the normal group, the experimental group, and control group, and within each group at different time points (all P>0.05). The abundance of Gardnerella and Atopobium in the experimental group was significantly higher at week 0 compared with 4th week and 8th week (all P<0.001). However, after estrogen treatment, the abundance of Gardnerella and Atopobium in the experimental group at 4th week was significantly lower than those in control group (all P<0.001), with no significant difference compared with the normal group (all P>0.05). There were no significant differences in the abundance of Prevotella, L. Gasseri, and L. Iners among the normal group, the experimental group, and control group at week 0, 4th week and 8th week (all P>0.05). The abundance of L. Crispatus and L. Jensenii in the experimental group and control group at week 0 was significantly lower than that in the normal group (all P<0.001). The abundance of L. Crispatus in the experimental group at 4th week and 8th week was significantly higher than that in control group (all P<0.001), with no significant difference compared with the normal group ( P>0.05). There were no significant differences in the concentrations of interleukin (IL)-6, IL-8, and interferon (IFN)-α in vaginal lavage fluid among the normal group, the experimental group, and control group (all P>0.05). The concentration of IL-1β in the experimental group and control group was significantly higher than that in the normal group ( P<0.001), with no significant difference between the experimental group and control group ( P>0.05). The concentration of tumor necrosis factor alpha (TNF-α) in the experimental group at 8th week was significantly lower than that at week 0 ( P<0.001), while there was no significant difference in TNF-α concentration after week 4 compared with week 0 ( P>0.05). Compared with the experimental group at week 0, the concentration of chemokine C-X-C motif ligand 14 (CXCL14) and IFN-β significantly decreased after 8 weeks of estrogen treatment (all P<0.001), with no significant change after 4 weeks of treatment ( P>0.05). Compared with the normal group, the concentration of IFN-γ inducible protein 16 in the experimental group and control group significantly increased (all P<0.001), with no significant difference between the experimental group and control group ( P>0.05). Conclusion:HPV infection can increase the abundance of Gardnerella and Atopobium in the vagina of postmenopausal women and decrease the abundance of L. Crispatus and L. Jensenii, which further disrupts the homeostasis of microorganisms in the vaginal microenvironment. Estrogen replacement therapy has a certain improvement effect on vaginal flora and local immunity in postmenopausal women with high-risk HPV infection.

Objective:To investigate the effect of estrogen supplementation therapy on vaginal microbiota and local immunity of postmenopausal high-risk human papillomavirus (HPV) infected women.Methods:A total of 74 postmenopausal women who underwent gynecological examinations or visits at Department of Gynecology, Shanghai Ruijin Rehabilitation Hospital from June 2018 to June 2023 were included in this study. According to HPV test, they were divided into the high-risk HPV-negative women (normal group, n=14) and the high-risk HPV-positive women ( n=60). A randomized controlled clinical trial was designed. Within the high-risk HPV-positive women, they were further randomly assigned by using the random number table method to the experimental group (high-risk HPV-positive women receiving low-dose estrogen therapy orally, n=30) and control group (high-risk HPV-positive women not receiving low-dose estrogen therapy, n=30). Vaginal microbiota composition and expression of inflammatory cytokines in vaginal lavage fluid were measured using fluorescence quantitative PCR and enzyme-linked immunosorbent assay at baseline (week 0), 4th week, and 8th week after enrollment. Results:There were no significant differences in age, menopausal time, body mass index, systolic pressure, diastolic pressure, heart rate, pH value and vaginal cell maturation index (VMI) among the normal group, the experimental group and control group (all P>0.05) which indicated the baseline was comparable. After estrogen treatment, the pH value of the experimental group at 4th and 8th weeks (5.27±0.13, 4.84±0.15) was significantly lower than that at week 0 (6.59±0.17, all P<0.001), while the vaginal cell maturation index (VMI) at 4th and 8th weeks (41.62±2.62, 58.28±2.16) was significantly higher than that at week 0 (25.97±2.60, all P<0.001). The quantitative results showed no significant differences in the abundance of Escherichia coli among the normal group, the experimental group, and control group, and within each group at different time points (all P>0.05). The abundance of Gardnerella and Atopobium in the experimental group was significantly higher at week 0 compared with 4th week and 8th week (all P<0.001). However, after estrogen treatment, the abundance of Gardnerella and Atopobium in the experimental group at 4th week was significantly lower than those in control group (all P<0.001), with no significant difference compared with the normal group (all P>0.05). There were no significant differences in the abundance of Prevotella, L. Gasseri, and L. Iners among the normal group, the experimental group, and control group at week 0, 4th week and 8th week (all P>0.05). The abundance of L. Crispatus and L. Jensenii in the experimental group and control group at week 0 was significantly lower than that in the normal group (all P<0.001). The abundance of L. Crispatus in the experimental group at 4th week and 8th week was significantly higher than that in control group (all P<0.001), with no significant difference compared with the normal group ( P>0.05). There were no significant differences in the concentrations of interleukin (IL)-6, IL-8, and interferon (IFN)-α in vaginal lavage fluid among the normal group, the experimental group, and control group (all P>0.05). The concentration of IL-1β in the experimental group and control group was significantly higher than that in the normal group ( P<0.001), with no significant difference between the experimental group and control group ( P>0.05). The concentration of tumor necrosis factor alpha (TNF-α) in the experimental group at 8th week was significantly lower than that at week 0 ( P<0.001), while there was no significant difference in TNF-α concentration after week 4 compared with week 0 ( P>0.05). Compared with the experimental group at week 0, the concentration of chemokine C-X-C motif ligand 14 (CXCL14) and IFN-β significantly decreased after 8 weeks of estrogen treatment (all P<0.001), with no significant change after 4 weeks of treatment ( P>0.05). Compared with the normal group, the concentration of IFN-γ inducible protein 16 in the experimental group and control group significantly increased (all P<0.001), with no significant difference between the experimental group and control group ( P>0.05). Conclusion:HPV infection can increase the abundance of Gardnerella and Atopobium in the vagina of postmenopausal women and decrease the abundance of L. Crispatus and L. Jensenii, which further disrupts the homeostasis of microorganisms in the vaginal microenvironment. Estrogen replacement therapy has a certain improvement effect on vaginal flora and local immunity in postmenopausal women with high-risk HPV infection.