Subclinical hypothyroidism (SCH) is a subclinical state of mild hypothyroidism. In recent years, the impact of SCH on multiple systems of the body has gradually attracted attention. Although SCH patients usually do not have obvious clinical symptoms, studies have shown that SCH may be associated with a variety of chronic diseases, such as cardiovascular disease and metabolic syndrome. Due to the complex interrelationship between diabetes mellitus and thyroid disease, researchers have begun to pay attention to the potential impact of SCH on diabetic retinopathy (diabetic retinopathy, DR). This article aims to comprehensively review the current research progress on the impact of SCH on DR, and explore in depth the pathophysiological mechanisms, clinical manifestations, and treatment strategies, providing clinicians with more comprehensive diagnostic and treatment ideas.

BACKGROUND:The plantarflexor weakness is a common muscle defect in patients with spastic cerebral palsy and Charcot-Marie-Tooth,which clinically manifests abnormal gaits,and the relationship between plantarflexor weakness and abnormal gaits is unclear. OBJECTIVE:To explore the biomechanical behavior of the lower limb under the action of a single factor of plantarflexor weakness to reveal the mechanism of abnormal gait induced by plantarflexor weakness and to provide guidance for the rehabilitation training of patients with plantarflexor weakness. METHODS:A predictive framework of musculoskeletal multibody dynamics in the sagittal plane was established based on OpenSim Moco to predict lower limb joint angles and muscle activation changes during walking in normal subjects.The validity of the framework was verified by combining the inverse kinematics and electromyogram activation time of the experimental data.Reduced isometric muscle forces were used to model plantarflexor weakness and to compare predicted lower extremity joint angles,joint moments,and muscle energy expenditure with normal subjects to analyze the effects of plantarflexor weakness on lower extremity biomechanics. RESULTS AND CONCLUSION:(1)The Moco-based prediction framework realistically predicted the biomechanical changes of the lower limbs during walking in normal subjects(joint angles:normalized correlation coefficient≥0.73,root mean square error≤7.10°).(2)The musculoskeletal model used a small stride support phase to increase the"heel-walking"gait during plantarflexor weakness.When the plantarflexor weakness reached 80%,the muscle energy expenditure was 5.691 4 J/kg/m,and the maximum activation levels of the gastrocnemius and soleus muscles were 0.72 and 0.53,which might cause the plantarflexor weakness patients to be more prone to fatigue when walking.(3)Muscle energy expenditure was significantly higher when the weakness of plantarflexors exceeded 40%,and the joint angles and moments of the lower limbs deteriorated significantly when the weakness of plantarflexors exceeded 60%,suggesting that there may be a"threshold"for the effect of plantarflexor weakness on gait,which may correspond to the point at which health care professionals should intervene in the clinical setting.

Objective To construct a predictive model for ulcer recurrence in patients with lower limb venous ulcers based on logistic regression analysis.Methods A total of 198 patients with lower limb venous ulcers admitted to our hospital from January 2022 to June 2023 were selected as research subjects.All patients received surgical treatment and were divided into recurrence and non-recurrence groups based on postoperative recurrence status.Clinical data including general information,lifestyle habits,comorbidities,postoperative be-haviors,and surgical details were collected.Univariate and multivariate logistic regression analyses were used to identify risk factors for ulcer recurrence and construct a predictive model.The Hosmer-Lemeshow test was used to evaluate the goodness-of-fit of the model,while ROC curves and AUC assessed predictive perform-ance.Results Among 198 patients with lower limb venous ulcers,44 experienced postoperative ulcer recur-rence(22.22%recurrence rate).Age≥65 years,superficial femoral valve repair,non-compliance,and high ligation of the great saphenous vein were independent risk factors for recurrence(P<0.05).The model's AUC was 0.926(95%CI:0.865 to 0.987).Conclusion The predictive model for ulcer recurrence in lower limb venous ulcer patients demonstrates high clinical value for guiding early intervention and prevention.

Objective:To explore the effect of a nurse-led family resilience intervention program on the primary caregivers of children with Hirschsprung′s disease, and provide reference for family resilience nursing intervention measures for pediatric chronic diseases.Methods:Using a randomized controlled trial method, a convenience sampling method was used to select 60 primary caregivers of first-time diagnosed Hirschsprung′s disease who were admitted to the pediatric surgery ward of the First Affiliated Hospital of Zhengzhou University from November 2022 to October 2023. Random digital table method was used to divide the primary caregivers into control group and observation group,with 30 cases in each group. The control group received routine care intervention, while the observation group received a nurse-led intervention program to enhance family resilience. The family resilience, depression,Family APGAR Index, and nursing satisfaction scores of the two groups before and after the intervention were compared.Results:Two groups of 30 patients each completed this study.There were 3 males and 27 females in the control group. The age was (28.61 ± 3.16) years old. There were 2 males and 28 females in the observation group. The age was (29.43 ± 3.48) years old.Before intervention, there were no statistically significant differences (all P>0.05) in the total family resilience score and its various dimensions, depression level, and family care score between the two groups of children′s primary caregivers. After intervention, the total score of family resilience of the main caregivers in the observation group was (142.53 ± 6.00) points,higher than (128.27 ± 5.06) points in the control group, the difference was significant ( t=-9.95, P<0.05). The depression score of the main caregivers in the observation group was (48.07 ± 8.46) points, and the family care score was (7.73 ± 0.98) points, which was better than the depression level of the main caregivers in the control group (50.77 ± 9.35) and the family care score (6.97 ± 1.00) ( t=2.49, -3.00, both P<0.05). After implementing intervention, the satisfaction level of the main caregivers in the observation group was 100.0%(30/30), higher than 83.3%(25/30) in the control group, the difference was significant ( χ2=6.41, P<0.05). Conclusions:The nurse-led family resilience improvement intervention program can effectively improve the family resilience and family care level of primary caregivers of children with Hirschsprung′s disease for the first time, which is helpful to improve the negative psychological emotions of primary caregivers and improve their satisfaction with nursing services.

Objective To analyze the differences in the initial stability of an acetabular cup with a Voronoi polyhedral porous structure and a solid acetabular cup and to explore the impact of the Voronoi polyhedral porous layer on the initial stability of the acetabular cup,as well as its role in preventing loosening and dislocation.Methods Voronoi polyhedral porous scaffold structures with 60％and 70％porosities were designed using the Grasshopper software.Specimens of porous acetabular cups with 60％and 70％porosities and solid acetabular cups were manufactured using selective laser melting technology.Lever tests on the acetabular cups were conducted using polyurethane block models under identical conditions,and the maximum lever-out moment,angular displacement,and interface stiffness of the three groups of specimens were analyzed and compared.Results Under the condition of no significant differences in the compression force,for porous acetabular cups with porosities of 60％and 70％,the maximum lever-out moment increased by 278.82％and 320.56％,the angular displacement increased by 194.04％and 269.23％,respectively,and the interface stiffness increased by 18.58％and 7.88％,respectively,compared with that of solid acetabular cups.After the lever-out tests were completed,significant wear was observed within the polyurethane block hemisphere cavity using the porous acetabular cups.Conclusions The initial stability indicators of acetabular cups with a Voronoi polyhedral porous structure were higher than those of solid acetabular cups,indicating that the Voronoi polyhedral porous layer can enhance the initial stability of the acetabular cup.These results provide a reference for designing and selecting acetabular components.

Reconstructing three-dimensional (3D) models from two-dimensional (2D) images is necessary for preoperative planning and the customization of joint prostheses. However, the traditional statistical modeling reconstruction shows a low accuracy due to limited 3D characteristics and information loss. In this study, we proposed a new method to reconstruct the 3D models of femoral images by combining a statistical shape model with Laplacian surface deformation, which greatly improved the accuracy of the reconstruction. In this method, a Laplace operator was introduced to represent the 3D model derived from the statistical shape model. By coordinate transformations in the Laplacian system, novel skeletal features were established and the model was accurately aligned with its 2D image. Finally, 50 femoral models were utilized to verify the effectiveness of this method. The results indicated that the precision of the method was improved by 16.8%-25.9% compared with the traditional statistical shape model reconstruction. Therefore, the method we proposed allows a more accurate 3D bone reconstruction, which facilitates the development of personalized prosthesis design, precise positioning, and quick biomechanical analysis.
Imaging, Three-Dimensional/methods* ; Tomography, X-Ray Computed/methods* ; Femur/surgery* ; Models, Statistical ; Lower Extremity

Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery[anterior cervical discectomy and fusion (ACDF) + cervical disc arthroplasty ( CDA)] and three-level ACDF. Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data. Three models were simulated by the implantation of Prestige LP and Zero-P prostheses, including two Hybrid models (AFA, Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment; FAF, Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF). The changes in range of motion (ROM) of adjacent levels during flexion, extension, lateral bending and axial rotation, the overall ROM, as well as the intradiscal pressure ( IDP) and facet contact force ( FCF) of adjacent levels were compared. Results The ROM in adjacent levels and the overall ROM of the AFA modelwere closer to the intact model, and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15. 0% and 23. 4% , respectively. For AFA, FAF and FFF models, the maximum increases in the maximum IDP of adjacent levels were 19. 0% , 66. 7% , 147. 6% , and the maximum increases in FCF were 17. 4% , 55. 7% , 80. 1% , respectively. Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

Objective:To investigate the clinical efficacy of anal dimple anorectoplasty on female infants with congenital anal atresia combined rectal vestibular fistula.Methods:Clinical data of 69 female infants with congenital anal atresia combined rectal vestibular fistula admitted to Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from July 2012 to July 2022 were retrospectively analyzed.They were divided into 2 groups according to the surgical methods: 34 cases of anal dimple anorectoplasty(group A) and 35 cases of anterior sagittal anorectoplasty(group B). The operation time, length of stay, short-term complications, long-term complications and bowel function (determined by the Rintala score at 6 months postoperatively) of the two groups were compared.The difference in the incidence of postoperative complications between groups was compared by Chi- square test, and the remaining differences between groups were compared by the paired t-test. Results:The operative time [(80.18±9.29) min vs.(103.85±8.26) min] and postoperative hospital stay[(6.10±1.52) d vs.(7.63±2.40) d] in group A were significantly shorter than those of group B ( t=11.40, 2.62; all P<0.05). The Rintala total score at 6 months postoperatively in group A was significantly higher than that of group B[(19.36±0.93) points vs.(18.76±0.44) points]( t=3.20, P<0.05). There were no significant differences in the incidences of short-term [(4/34, 11.8%) vs.(7/35, 20.0%)] and long-term complications [(2/34, 5.9%) vs.(4/35, 11.4%)]between group A and group B ( χ2=0.75, 0.75; all P>0.05). Conclusions:Anal dimple anorectoplasty for female infants with congenital anal atresia combined rectal vestibular fistula is safe and effective.

Objective:To survey the health literacy and related factors of family caregivers of patients with chronic diseases in Beijing.Methods:A survey was conducted from September to November 2018, among 1 350 family caregivers of patients with chronic diseases selected by stratified random sampling from 6 districts of Beijing. A self-filling questionnaire was used for the survey, which consisted of the basic information and health literacy of family caregivers. Health literacy included three parts: daily living habits, basic knowledge (knowledge of prevention and management of behavioral risk factors, knowledge related to chronic diseases and knowledge related to first aid) and chronic disease-related skills.Results:A total of 1 268 valid questionnaires were collected with a recovery rate of questionnaires was 93.9%. The median age of 1 268 family caregivers was 62 years (23-86) and 75.7% (960/1 268) were females. In terms of daily habits, smokers and drinkers accounted for 11.3% (143/1 268) and 21.5% (272/1 268) respectively; 82.7% (1 049/1 268) caregivers exercised regularly accounted, of whom 72.5% (761/1 049) exercised at least 4 times a week; 28.9% (366/1 268) caregivers had habit of light diet. In terms of basic knowledge of health literacy, 12.9% (163/1 268) of family caregivers mastered the basic knowledge (≥80% total score); family caregivers who were able to measure blood pressure, blood sugar, pulse, coping with hypoglycemia, cardiopulmonary resuscitation and dialing the emergency number correctly accounted for 27.4% (347/1 268), 18.1% (230/1 268), 15.1% (191/1 268), 15.7% (199/1 268), 6.0% (76/1 268) and 33.8% (429/1 268), respectively. For the six chronic disease-related skills, 23.7% (301/1 268) were able to call emergency number correctly and only 2.6% (33/1 268) were able to perform CPR. There were significant differences in the knowledge of behavioral risk factors ( χ 2=3.88, P=0.017), chronic disease related knowledge ( χ2=7.40, P=0.025), first-aid related knowledge ( χ2=12.04, P=0.002) and overall basic knowledge ( χ2=13.56, P=0.001) among family caregivers with different educational levels. There were significant differences in the knowledge of chronic diseases among family caregivers in different occupations ( χ2=8.78, P=0.012). Conclusion:The health literacy level of family caregivers of patients with chronic diseases in Beijing needs to be further improved, and there are differences in the health literacy of family caregivers with different educational qualifications and occupations.

Ebola virus (EBOV) is an enveloped negative-sense RNA virus and a member of the filovirus family. Nucleoprotein (NP) expression alone leads to the formation of inclusion bodies (IBs), which are critical for viral RNA synthesis. The matrix protein, VP40, not only plays a critical role in virus assembly/budding, but also can regulate transcription and replication of the viral genome. However, the molecular mechanism by which VP40 regulates viral RNA synthesis and virion assembly/budding is unknown. Here, we show that within IBs the N-terminus of NP recruits VP40 and is required for VLP-containing NP release. Furthermore, we find four point mutations (L692A, P697A, P698A and W699A) within the C-terminal hydrophobic core of NP result in a stronger VP40-NP interaction within IBs, sequestering VP40 within IBs, reducing VP40-VLP egress, abolishing the incorporation of NC-like structures into VP40-VLP, and inhibiting viral RNA synthesis, suggesting that the interaction of N-terminus of NP with VP40 induces a conformational change in the C-terminus of NP. Consequently, the C-terminal hydrophobic core of NP is exposed and binds VP40, thereby inhibiting RNA synthesis and initiating virion assembly/budding.
Ebolavirus/physiology* ; HEK293 Cells ; HeLa Cells ; Humans ; Nucleocapsid Proteins/metabolism* ; RNA, Viral/metabolism* ; Viral Matrix Proteins/metabolism* ; Virion/metabolism* ; Virus Assembly