Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Knee osteoarthritis is a common joint disease within osteoarthritis,characterized by pain,swelling,and limited functionality as the main clinical manifestations.In severe cases,it affects daily life and falls under the category of"impediment syndrome"or"bone impediment"in TCM.The author believes that the theory of"bones,tendons,and muscles"is closely related to this disease.Treatment should focus on simultaneously nourishing the liver,spleen and kidneys,considering tendons,bones and muscles,while also dispelling wind,cold and dampness.The clinical application of Sanbi Decoction has shown good efficacy,and this discussion aimed to provide ideas for the diagnosis and treatment of knee osteoarthritis.

Gout significantly impacts both physical health and quality of life,while current pharmacological treatments face notable limitations.TCM non-pharmacological therapies have shown promising potential in the management of gout,offering diverse approaches with favorable efficacy.This article summarized the characteristics,clinical efficacy and mechanisms of different TCM non-pharmacological therapies for treating gout.Recent studies suggest that these therapies may be applied across all clinical stages of gout.During the acute phase,they can rapidly reduce joint inflammation and relieve pain.In the intercritical phase,they help prevent recurrence,decrease the frequency of attacks,and shorten episode duration.In the chronic tophaceous phase,they alleviate persistent symptoms,improve joint function,and support minimally invasive tophi removal.TCM non-pharmacological therapies have their own characteristics and good safety,and can be combined for clinical use,providing TCM treatment strategies for gout.

Gout significantly impacts both physical health and quality of life,while current pharmacological treatments face notable limitations.TCM non-pharmacological therapies have shown promising potential in the management of gout,offering diverse approaches with favorable efficacy.This article summarized the characteristics,clinical efficacy and mechanisms of different TCM non-pharmacological therapies for treating gout.Recent studies suggest that these therapies may be applied across all clinical stages of gout.During the acute phase,they can rapidly reduce joint inflammation and relieve pain.In the intercritical phase,they help prevent recurrence,decrease the frequency of attacks,and shorten episode duration.In the chronic tophaceous phase,they alleviate persistent symptoms,improve joint function,and support minimally invasive tophi removal.TCM non-pharmacological therapies have their own characteristics and good safety,and can be combined for clinical use,providing TCM treatment strategies for gout.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Knee osteoarthritis is a common joint disease within osteoarthritis,characterized by pain,swelling,and limited functionality as the main clinical manifestations.In severe cases,it affects daily life and falls under the category of"impediment syndrome"or"bone impediment"in TCM.The author believes that the theory of"bones,tendons,and muscles"is closely related to this disease.Treatment should focus on simultaneously nourishing the liver,spleen and kidneys,considering tendons,bones and muscles,while also dispelling wind,cold and dampness.The clinical application of Sanbi Decoction has shown good efficacy,and this discussion aimed to provide ideas for the diagnosis and treatment of knee osteoarthritis.

Objective To explore the prevalence of uremic pruritus(UP)in patients with maintenance hemodialy-sis(MHD)in Anhui Province and its influential factors.Methods Patients with MHD were enrolled in 27 hemo-dialysis centers in Anhui Province.Clinical data were compared.Results A total of 3 025 patients with MHD were included.The prevalence of UP was 63.3%,among them,mild UP 55.9%and moderate to severe UP 7.4%.The prevalence rates of UP in southern Anhui,central Anhui and northern Anhui were 75.4%,63.6%and 57.9%.The prevalence of total UP in≤30 years,31-50 years,51-70 years and≥71 years was 53.5%,59.8%,65.4%and 65.9%.The prevalence of total UP and moderate to severe UP increased with age(P<0.01).Age,age of dialysis,proportion of hypertension,25(hydroxy)vitamin D3[25(OH)D3],proportion of low flux dialyzer usage and proportion of calcium-phosphorus binder usage in UP group were higher than those in the group without UP.However,the levels of diastolic blood pressure,hemoglobin(Hb)and hemodialysis filtration ratio in the UP group were lower than those in the non-UP group(P<0.05).By comparison,the age,hyperten-sion and diabetes of patients in moderate and severe UP group were higher than those in mild UP group,while the proportion of non-calcium-phosphorus binding was lower than that in mild UP group(P<0.05).Binary Logistic regression analysis showed that high 25(OH)D3 was associated with a higher risk of UP in MHD patients,and high throughput dialyzer use was associated with a lower risk of UP in MHD patients(P<0.05).Conclusion The prevalence rate of UP in maintenance hemodialysis patients in Anhui province is 63.3%.The prevalence of UP is the highest in southern Anhui,and the prevalence of total UP and moderate to severe UP increases with age.High 25(OH)D3 levels are a risk factor for UP in MHD patients,and the use of high-throughput dialyzers can reduce the risk of UP in MHD patients.

BACKGROUND:Intervertebral disc degeneration is caused by damage and degeneration of the nucleus pulposus and annulus fibrosus tissues inside the intervertebral disc,resulting in structural and functional changes of the intervertebral disc.However,there is yet no effective drug treatment for intervertebral disc degeneration. OBJECTIVE:To investigate the inhibitory effect of syringin on intervertebral disc degeneration. METHODS:A total of 10 male Sprague-Dawley rats were selected,and the coccygeal intervertebral disc(Co4/Co5)of each rat was set as model group,Co5/Co6 intervertebral disc as syringin group,and Co6/Co7 intervertebral disc as control group.The control group did not receive any treatment.In the model group and syringin group,a miniature puncture needle was used to puncture the annulus fibrosus to establish an intervertebral disc degeneration model.Immediately after modeling,2.5 μL of normal saline and syringin solution(5 μmol/L)were given in the model and syringin groups,respectively.Four weeks after injection,the samples were taken.The degree of intervertebral disc degeneration in rats was observed by hematoxylin-eosin and safranine O-fast green staining.The expressions of type Ⅱ collagen,aggrecan and matrix metalloproteinases 3 and 13 in intervertebral disc tissue were analyzed by immunohistochemical staining. RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that in the model group,the height of intervertebral disc decreased,the cartilage endplate became thinner and cracked,the fibrous ring structure was disordered and cracked,and the nucleus pulposus disappeared;in the syringin group,the height of intervertebral disc was normal or slightly lower than that in the control group,the degree of cartilage endplate degeneration was lighter than that in the model group,the fiber circle permutation was relatively regular with no cracks,and the nucleus pulposus was partially shrunk.Safranine O-fast green staining showed that in the model group,the cartilage endplate of the intervertebral disc was defective and the calcified layer of cartilage became thinner,showing obvious degeneration.The structure and morphology of intervertebral disc cartilage endplate in the syringin group recovered to some extent.Immunohistochemical staining showed that,compared with the control group,the expressions of type Ⅱ collagen and aggrecan in the intervertebral disc cartilage were decreased in the model group(P<0.000 1),while the expressions of matrix metalloproteinases 3 and 13 increased(P<0.000 1).Compared with the model group,the expressions of type Ⅱ collagen and aggrecan in the intervertebral disc cartilage tissue were increased in the syringin group(P<0.001,P<0.000 1),while the expressions of matrix metalloproteinases 3 and 13 decreased(P<0.001,P<0.000 1).These results showed that syringin could improve the structure and function of intervertebral disc by inhibiting the expression of matrix metalloproteinases 3 and 13 and increasing the expression of type Ⅱ collagen and aggrecan,thus preventing and slowing down the procession of intervertebral disc degeneration.

Objective:To provide references for effective intervention of hyperuricemia (HUA) by investigating the prevalence of HUA in military pilots and analyzing its relevant influencing factors.Methods:The physical examination data of 2 700 military pilots who received physical examinations from January 2021 to October 2023 were retrospectively analyzed. The above pilots were divided into HUA group and non-HUA group according to whether they had HUA. The differences in age, height, weight, body mass index, flying hours, blood pressure, blood uric acid, fasting blood glucose, total bilirubin, albumin, blood urea nitrogen, blood creatinine, alanine aminotransferase, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol levels, as well as the prevalence of hypertension, hyperlipidemia, and fatty liver were compared between 2 groups. The pilots were grouped by age (≤29 years, 30-39 years, 40-49 years,≥50 years) and by the aircraft types (fighter, bombers, transporter, helicopter). The criteria for determining HUA, hypertension, hyperlipidemia, and fatty liver were based on the relevant guidelines. The influencing factors for the prevalence of HUA were analyzed through binary Logistic regression. Single factor binary Logistic regression was used to analyze the influencing factors of the prevalence of HUA in pilots, and P<0.05 index was included in multi-factor binary Logistic regression to further analyze the influencing factors of the occurrence of HUA. Results:There were 821 cases (30.41%) in HUA group and 1 879 cases (69.59%) in non-HUA group. The weight ( t=7.75, P<0.001), body mass index ( t=8.23, P<0.001), systolic blood pressure ( t=3.20, P=0.001), diastolic blood pressure ( t=3.06, P=0.002), serum uric acid ( t=62.83, P<0.001), blood urea nitrogen ( t=3.41, P=0.001), serum creatinine ( t=8.88, P<0.001), alanine aminotransferase ( t=5.56, P<0.001), total cholesterol ( t=3.27, P=0.001), triglyceride ( Z=9.54, P<0.001), as well as the prevalence of hypertension ( χ2=7.48, P=0.006), hyperlipidemia ( χ2=42.74, P<0.001), and fatty liver ( χ2=22.51, P<0.001) in HUA group were higher than those in non-HUA group, while high-density lipoprotein cholesterol was lower than that in the non-HUA group, and the difference was significant ( t=5.91, P<0.001). There was no significant difference in the prevalence of HUA among pilots of different age groups and aircraft types (both P>0.05). Overweight ( OR=1.392, 95% CI: 1.159-1.672), obesity ( OR=1.891, 95% CI: 1.197-2.987), and elevated level of triglyceride ( OR=1.246, 95% CI:1.128-1.377), blood urea nitrogen ( OR=1.079, 95% CI:1.000-1.163), and serum creatinine ( OR=1.036, 95% CI:1.028-1.044) were risk factors for HUA, and elevated high density lipoprotein cholesterol ( OR=0.567, 95% CI: 0.389-0.825) was a protective factor. Conclusions:The prevalence of HUA in military pilots is higher than that in the general population. Overweight, obesity, and elevated level of triglyceride, blood urea nitrogen, and serum creatinine are closely related to the prevalence of HUA, and comprehensive intervention measures should be taken for key targets.

Objective:To provide references for effective intervention of hyperuricemia (HUA) by investigating the prevalence of HUA in military pilots and analyzing its relevant influencing factors.Methods:The physical examination data of 2 700 military pilots who received physical examinations from January 2021 to October 2023 were retrospectively analyzed. The above pilots were divided into HUA group and non-HUA group according to whether they had HUA. The differences in age, height, weight, body mass index, flying hours, blood pressure, blood uric acid, fasting blood glucose, total bilirubin, albumin, blood urea nitrogen, blood creatinine, alanine aminotransferase, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol levels, as well as the prevalence of hypertension, hyperlipidemia, and fatty liver were compared between 2 groups. The pilots were grouped by age (≤29 years, 30-39 years, 40-49 years,≥50 years) and by the aircraft types (fighter, bombers, transporter, helicopter). The criteria for determining HUA, hypertension, hyperlipidemia, and fatty liver were based on the relevant guidelines. The influencing factors for the prevalence of HUA were analyzed through binary Logistic regression. Single factor binary Logistic regression was used to analyze the influencing factors of the prevalence of HUA in pilots, and P<0.05 index was included in multi-factor binary Logistic regression to further analyze the influencing factors of the occurrence of HUA. Results:There were 821 cases (30.41%) in HUA group and 1 879 cases (69.59%) in non-HUA group. The weight ( t=7.75, P<0.001), body mass index ( t=8.23, P<0.001), systolic blood pressure ( t=3.20, P=0.001), diastolic blood pressure ( t=3.06, P=0.002), serum uric acid ( t=62.83, P<0.001), blood urea nitrogen ( t=3.41, P=0.001), serum creatinine ( t=8.88, P<0.001), alanine aminotransferase ( t=5.56, P<0.001), total cholesterol ( t=3.27, P=0.001), triglyceride ( Z=9.54, P<0.001), as well as the prevalence of hypertension ( χ2=7.48, P=0.006), hyperlipidemia ( χ2=42.74, P<0.001), and fatty liver ( χ2=22.51, P<0.001) in HUA group were higher than those in non-HUA group, while high-density lipoprotein cholesterol was lower than that in the non-HUA group, and the difference was significant ( t=5.91, P<0.001). There was no significant difference in the prevalence of HUA among pilots of different age groups and aircraft types (both P>0.05). Overweight ( OR=1.392, 95% CI: 1.159-1.672), obesity ( OR=1.891, 95% CI: 1.197-2.987), and elevated level of triglyceride ( OR=1.246, 95% CI:1.128-1.377), blood urea nitrogen ( OR=1.079, 95% CI:1.000-1.163), and serum creatinine ( OR=1.036, 95% CI:1.028-1.044) were risk factors for HUA, and elevated high density lipoprotein cholesterol ( OR=0.567, 95% CI: 0.389-0.825) was a protective factor. Conclusions:The prevalence of HUA in military pilots is higher than that in the general population. Overweight, obesity, and elevated level of triglyceride, blood urea nitrogen, and serum creatinine are closely related to the prevalence of HUA, and comprehensive intervention measures should be taken for key targets.