ObjectiveTo evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) for muscle atrophy in patients with immobilization after surgical fixation of foot and ankle fractures.MethodsThis was a two-arm randomized controlled trial wherein 80 patients were recruited and divided into control (n = 40) and intervention (n = 40) groups. The control group received conventional orthopedic treatment, whereas the intervention group received TEAS and conventional treatment. The intervention group received TEAS 3 times a week for 30 min each time for 8 weeks. The primary outcomes were muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris and gastrocnemius muscles, whereas the secondary outcome measure was echo intensity (EI). Data were collected before the fixation operations (baseline assessment) and 4 and 8 weeks after intervention.ResultsCompared with baseline, the MT and CSA were reduced in both groups by the end of treatment, whereas EI increased in both groups. At week 4, the reduction in the rectus femoris CSA in the intervention group was significantly lower than that in the control group (P = .02); however, the between-group differences in the MT and EI (all P .05) were not significant. No serious adverse events were observed in either group.ConclusionOur study showed that TEAS can improve muscle atrophy by attenuating the decline in the muscle CSA. Because this was only a pilot trial, subsequent studies will need longer follow-ups and larger sample sizes.

Objective:To analyze the impact of preoperative controlling nutritional status (CONUT) score on the prognosis of gallbladder cancer patients with curative resection.Methods:The clinical data of gallbladder cancer patients, treated at Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital from January 2016 to December 2023 were retrospectively analyzed. A total of 184 patients were enrolled in this study, including 84 males and 100 females, aged (67.6±9.5) years. Based on preoperative CONUT score, 184 patients were divided into the low-score group (0-3 points, n=138) and the high-score group (4-12 points, n=46). The clinicopathological features including age, preoperative carbohydrate antigen 125 level, maximum tumor diameter, vascular invasion, postoperative T stage and postoperative hospital length of stay, were compared between two groups. Univariate and multivariate Cox regression analysis were performed to analyze the relationship between preoperative CONUT score and prognosis of gallbladder cancer patients with curative resection. Results:The age, preoperative carbohydrate antigen 125 level, maximum tumor diameter, vascular invasion ratio, postoperative T stage and postoperative hospital length of stay in the high-score group were higher than those in the low-score group, and the differences were statistically significant (all P<0.05). Multivariate Cox regression analysis revealed that high CONUT score (4-12 points) was associated with a higher risk of poor overall survival ( HR=1.932, 95% CI: 1.165-3.203, P=0.011) and poor recurrence-free survival ( HR=1.600, 95% CI: 1.002-2.554, P=0.049). Conclusion:CONUT score (4-12 points) is a risk factor for poor overall survival and recurrence-free survival. Assessment of the CONUT score is an important preoperative consideration.

Objective:To analyze the correlation between blood glucose index and peripheral neuropathy in type 2 diabetes patients under continuous blood glucose monitoring.Methods:A total of 110 patients with type 2 diabetes admitted to the Lu′an Hospital Affiliated to Anhui Medical University from November 2022 to January 2024 were retrospectively observed, and the blood glucose indexes of patients were monitored by continuous glucose meter [glucose time in range (TIR), mean blood glucose (MBG), estimated hemoglobin A 1c (eHbA 1c), blood glucose standard deviation (SD), coefficient of variation (CV), largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE), means of daily differences (MODD), etc ]. All patients with type 2 diabetes were grouped according to whether they had peripheral neuropathy or not, and were divided into the developing group and the non-developing group. General data and blood glucose indexes of the two groups were collected and sorted out. Receiver operating characteristic (ROC) curve was used to analyze the value of various blood glucose indicators in predicting peripheral neuropathy in patients with type 2 diabetes. Spearman correlation analysis was also used to evaluate the correlation between blood glucose index and peripheral neuropathy. Results:The disease course, TIR, MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD of the occurrence group were significantly different from those of the non-occurrence group (all P<0.05). By plotting the ROC curve, It was found that the area under the curve (AUC) of TIR, MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD predicting peripheral neuropathy in patients with type 2 diabetes were 0.942, 0.840, 0.705, 0.759, 0.819, 0.813, 0.857 and 0.677, respectively. The AUC of the combined prediction was 0.971(95% CI: 0.946-0.997), which was higher than that of the single indicator (all P<0.05). Spearman correlation assessment showed a negative correlation between TIR and peripheral neuropathy ( r=-0.738, P<0.05). MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD were positively correlated with peripheral neuropathy ( r=0.554, 0.376, 0.452, 0.490, 0.527, 0.625, 0.272, all P<0.05). Conclusions:Based on continuous blood glucose monitoring, the blood glucose index of type 2 diabetes patients is closely related to peripheral neuropathy, and the above blood glucose index can accurately predict peripheral neuropathy, providing a reference for reducing or preventing the occurrence of peripheral neuropathy.

Objective:To explore the association of serum levels of 41 serum cytokines and growth factors with the risk of sero-negative rheumatoid arthritis(SNRA)by Mendelian randomization.Methods:Genetic instruments for 41 circulating cytokines and growth factors were determined from a genome-wide association study(GWAS)of 8 293 European participants.Summary statistics for the SNRA were obtained from the Finnish database,including 3 877 SNRA cases and 285 035 controls of European ancestry.All of the inverse variance weighted(IVW),weighted median method(WM)and MR-Egger regression were used for MR analysis,while the IVW method was considered as the main analysis.The sensitivity analysis included a heterogeneity test,horizontal pleiotropic test,and leave-one method test to determine the reliability of the MR results.Results:In the IVW method,TNF-α[OR=1.470,95%CI(1.1331～1.910),P=0.004],IP-10[OR=0.794,95%CI(0.660～0.955),P=0.015]and IL-2rα[OR=0.049,95%CI(0.856～0.999),P=0.049].Sensitivity analysis showed no heterogeneity and horizontal pleiotropy.Conclusion:TNF-α,IP-10 and IL-2rα are causally associated to SNRA.TNF-α increases the risk of SNRA,while IP-10 and IL-2rα reduce the risk of SNRA.

Agenesis of the dorsal pancreas(ADP)is an extremely rare congenital pancreatic malformation characterized by the absence or hypoplasia of the pancreatic body and tail.Its pathogenesis is closely related to abnormal embryonic development of the ventral and dorsal pancreatic buds,governed by a complex network of transcription factors,including HLXB9,HNF1B,PDX1,PTF1A,GATA4,and GATA6.The clinical spectrum of ADP is highly variable,ranging from asymptomatic cases to manifestations such as abdominal pain,diabetes mellitus,or pancreatitis.Imaging modalities-including ultrasonography,CT,magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangio-pancreatography-serve as the main diagnostic tools,with characteristic findings of absent pancreatic body and tail accompanied by compensatory enlargement of the pancreatic head.ADP is frequently associated with congenital anomalies of the kidney,biliary tract,cardiovascular system,or genital organs.Management is primarily symptomatic,with insulin replacement for diabetes and pancreatic enzyme supplementation for exocrine insufficiency.Advances in genetic sequencing and stem cell research have deepened understanding of the pathogenesis,genetic background,and potential therapeutic strategies of ADP.This review summarizes current progress in embryology,genetics,clinical features,diagnosis,and treatment of ADP,aiming to improve clinical recognition and guide future investigations.

Objective:To analyze the correlation between blood glucose index and peripheral neuropathy in type 2 diabetes patients under continuous blood glucose monitoring.Methods:A total of 110 patients with type 2 diabetes admitted to the Lu′an Hospital Affiliated to Anhui Medical University from November 2022 to January 2024 were retrospectively observed, and the blood glucose indexes of patients were monitored by continuous glucose meter [glucose time in range (TIR), mean blood glucose (MBG), estimated hemoglobin A 1c (eHbA 1c), blood glucose standard deviation (SD), coefficient of variation (CV), largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE), means of daily differences (MODD), etc ]. All patients with type 2 diabetes were grouped according to whether they had peripheral neuropathy or not, and were divided into the developing group and the non-developing group. General data and blood glucose indexes of the two groups were collected and sorted out. Receiver operating characteristic (ROC) curve was used to analyze the value of various blood glucose indicators in predicting peripheral neuropathy in patients with type 2 diabetes. Spearman correlation analysis was also used to evaluate the correlation between blood glucose index and peripheral neuropathy. Results:The disease course, TIR, MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD of the occurrence group were significantly different from those of the non-occurrence group (all P<0.05). By plotting the ROC curve, It was found that the area under the curve (AUC) of TIR, MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD predicting peripheral neuropathy in patients with type 2 diabetes were 0.942, 0.840, 0.705, 0.759, 0.819, 0.813, 0.857 and 0.677, respectively. The AUC of the combined prediction was 0.971(95% CI: 0.946-0.997), which was higher than that of the single indicator (all P<0.05). Spearman correlation assessment showed a negative correlation between TIR and peripheral neuropathy ( r=-0.738, P<0.05). MBG, eHbA 1c, SD, CV, LAGE, MAGE and MODD were positively correlated with peripheral neuropathy ( r=0.554, 0.376, 0.452, 0.490, 0.527, 0.625, 0.272, all P<0.05). Conclusions:Based on continuous blood glucose monitoring, the blood glucose index of type 2 diabetes patients is closely related to peripheral neuropathy, and the above blood glucose index can accurately predict peripheral neuropathy, providing a reference for reducing or preventing the occurrence of peripheral neuropathy.

Objective:To analyze the impact of preoperative controlling nutritional status (CONUT) score on the prognosis of gallbladder cancer patients with curative resection.Methods:The clinical data of gallbladder cancer patients, treated at Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital from January 2016 to December 2023 were retrospectively analyzed. A total of 184 patients were enrolled in this study, including 84 males and 100 females, aged (67.6±9.5) years. Based on preoperative CONUT score, 184 patients were divided into the low-score group (0-3 points, n=138) and the high-score group (4-12 points, n=46). The clinicopathological features including age, preoperative carbohydrate antigen 125 level, maximum tumor diameter, vascular invasion, postoperative T stage and postoperative hospital length of stay, were compared between two groups. Univariate and multivariate Cox regression analysis were performed to analyze the relationship between preoperative CONUT score and prognosis of gallbladder cancer patients with curative resection. Results:The age, preoperative carbohydrate antigen 125 level, maximum tumor diameter, vascular invasion ratio, postoperative T stage and postoperative hospital length of stay in the high-score group were higher than those in the low-score group, and the differences were statistically significant (all P<0.05). Multivariate Cox regression analysis revealed that high CONUT score (4-12 points) was associated with a higher risk of poor overall survival ( HR=1.932, 95% CI: 1.165-3.203, P=0.011) and poor recurrence-free survival ( HR=1.600, 95% CI: 1.002-2.554, P=0.049). Conclusion:CONUT score (4-12 points) is a risk factor for poor overall survival and recurrence-free survival. Assessment of the CONUT score is an important preoperative consideration.

Objective To compare the efficacy of artificial intelligence(AI)diagnostic group and artificial reading group in the diagnosis for osteoporotic vertebral compression fractures.Methods From January 2023 to December 2023,80 patients with osteoporotic vertebral compression fractures and 20 patients without fractures but with nonspecific low back pain were included in the study.According to the patient's computed tomography(CT)image,the AI software diagnosis and physicians of different seniority(one senior physician,one intermediate physician and one junior physician)diagnosis were performed.The diagnostic efficacy of different detection methods was compared.Results The sensitivity,specificity,positive predictive value,negative predictive value and area under the receiver operating characteristic(ROC)curve(AUC)and Kappa value of each group were as follows:AI image interpretation:0.975,0.900,0.975,0.900,0.938,0.875;senior physician:0.950,0.900,0.974,0.818,0.925,0.819;intermediate physician:0.825,0.850,0.957,0.548,0.837,0.560;and junior physician:0.750,0.750,0.923,0.429,0.751,0.390.Conclusion The diagnostic performance of AI was comparable to that of senior physician,and significantly higher than that of intermediate and primary physicians.

Objective To compare the efficacy of artificial intelligence(AI)diagnostic group and artificial reading group in the diagnosis for osteoporotic vertebral compression fractures.Methods From January 2023 to December 2023,80 patients with osteoporotic vertebral compression fractures and 20 patients without fractures but with nonspecific low back pain were included in the study.According to the patient's computed tomography(CT)image,the AI software diagnosis and physicians of different seniority(one senior physician,one intermediate physician and one junior physician)diagnosis were performed.The diagnostic efficacy of different detection methods was compared.Results The sensitivity,specificity,positive predictive value,negative predictive value and area under the receiver operating characteristic(ROC)curve(AUC)and Kappa value of each group were as follows:AI image interpretation:0.975,0.900,0.975,0.900,0.938,0.875;senior physician:0.950,0.900,0.974,0.818,0.925,0.819;intermediate physician:0.825,0.850,0.957,0.548,0.837,0.560;and junior physician:0.750,0.750,0.923,0.429,0.751,0.390.Conclusion The diagnostic performance of AI was comparable to that of senior physician,and significantly higher than that of intermediate and primary physicians.

Agenesis of the dorsal pancreas(ADP)is an extremely rare congenital pancreatic malformation characterized by the absence or hypoplasia of the pancreatic body and tail.Its pathogenesis is closely related to abnormal embryonic development of the ventral and dorsal pancreatic buds,governed by a complex network of transcription factors,including HLXB9,HNF1B,PDX1,PTF1A,GATA4,and GATA6.The clinical spectrum of ADP is highly variable,ranging from asymptomatic cases to manifestations such as abdominal pain,diabetes mellitus,or pancreatitis.Imaging modalities-including ultrasonography,CT,magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangio-pancreatography-serve as the main diagnostic tools,with characteristic findings of absent pancreatic body and tail accompanied by compensatory enlargement of the pancreatic head.ADP is frequently associated with congenital anomalies of the kidney,biliary tract,cardiovascular system,or genital organs.Management is primarily symptomatic,with insulin replacement for diabetes and pancreatic enzyme supplementation for exocrine insufficiency.Advances in genetic sequencing and stem cell research have deepened understanding of the pathogenesis,genetic background,and potential therapeutic strategies of ADP.This review summarizes current progress in embryology,genetics,clinical features,diagnosis,and treatment of ADP,aiming to improve clinical recognition and guide future investigations.