Objective To develop and validate a prediction model for risk of amputation in patients with diabetic foot ulcers(DFU)based on systematic review and meta-analysis.Methods The studies on the risk factors of amputation in DFU patients was retrieved by using subject words+free words.After screening,37 cohort studies were finally included,and the Newcastle-Ottawa scale(NOS)was used for quality evaluation.Meta-analysis was performed on the risk factors of amputation in DFU.Then a prediction model for DFU amputation risk were constructed based on the statistically significant risk factors in the meta-analysis.The corresponding β value was calculated based on the combined odds ratio(OR)value of each risk factor,and each risk factor was scored to establish a scoring system model.The clinical data of 453 DFU patients hospitalized in our department from 2021 to 2023 were collected as a validation cohort.Receiver operating characteristic(ROC)curve analysis was used to evaluate the model performance.The area under the curve(AUC)was calculated,and the optimal cutoff score was determined by calculation of the maximum Youden index through sensitivity and specificity.Results Our meta-analysis showed a cumulative amputation rate of approximately 34.65%in 11 779 DFU patients.The final risk prediction models include gangrene[OR=11.92(5.86～24.24)],ulcer depth[OR=4.93(2.52～9.64)],osteomyelitis[OR=3.19(2.36～4.29)],previous amputation history[OR=3.19(2.00～5.09)]and lower extremity arterial disease[OR=3.10(2.31～4.17)].According to the weights of each risk factor,the total score of the model is 76,and the optimal cut-off score is 36.5.The prediction model performed well,with an AUC value of 0.864(0.824,0.903),a sensitivity of 0.743,a specificity of 0.859,and an accuracy rate of 83.00%.Conclusion A prediction model for DFU amputation risk is developed based on risk factor scoring,and has good discrimination and calibration,providing effective scientific basis for clinical research and clinical decision-making related to DFU amputation.

Objective:To investigate the impact of four registration methods on the accuracy of virtual occlusal records (VOR) in intraoral scanning for implant restorations with multiple missing teeth.Methods:A mandibular model simulating clinical conditions with multiple missing teeth (right first molar, left second premolar, left first molar, left second molar) and a maxillary compete dentition model were mounted on a semi-adjustable articulator. Subsequently, twelve 0.5 mm stainless steel spheres were adhered to reference positions (16, 46, 13, 43, 23, 33, 25, 35, 26, 36, 27, 37) as fiducial markers. Following this, a laboratory scanner generated reference datasets by digitizing the models in maximum intercuspation (MIP). Meanwhile, ten maxillary and mandibular scans were acquired using an intraoral scanner, with all nonarticulated scans duplicated four times to ensure data consistency. Forty VOR intraoral scans were performed in MIP using four registration protocols: left-side, right-side, anterior, and bilateral registration ( n=10 per group), randomized via a computer-generated pseudo-random sequence. For measurement, linear distances (D16-46, D13-43, D23-33, D25-35, D26-36, D27-37, D16-46 represented the single-tooth defect position, whereas D25-35, D26-36, D27-37 reflected positions in free-end edentulism areas) between opposing markers were measured in a reverse engineering software, with deviations (ΔD) from the reference scan calculated to assess accuracy. Specifically, negative ΔD values indicated vertical dimension underestimation. Given that non-normally distributed data were analyzed using medians [interquartile ranges (IQR)], trueness (median ΔD) and precision (IQR) were evaluated. The interaction effect between the registration method and the position of the measurement items was evaluated by using the generalized linear model. The accuracy was compared overall by the Kruskal-Wallis test with the two-sided significance level of α=0.05. For pairwise comparisons, post-hoc tests were conducted by Dunn′s t-test with the Bonferroni correction for the significance level. Results:The accuracy of VOR was affected by registration method ( P<0.05), with a significant position×registration method interaction observed ( P<0.05). In particular, in all four groups, only the bilateral registration group showed trueness of less than 0.1 mm for both free-end edentulism and the single tooth defect, with ΔD16-46, ΔD25-35, ΔD26-36, and ΔD27-37 being 0.059 (0.015), -0.082 (0.052), -0.065 (0.032), -0.070 (0.050) mm, respectively. Moreover, trueness in free-end edentulism showed negative values across all groups, with the largest negative deviations observed in the right-side registration group, with ΔD25-35, ΔD26-36 and ΔD27-37 being -0.410 (0.174), -0.442 (0.225), -0.439 (0.262) mm, respectively. Conclusions:In fully digital workflows of implant restorations for mandibular free-end edentulism with multiple missing teeth, registration method critically influences VOR accuracy. While four registration methods exhibited underestimation of occlusal vertical dimension, bilateral registration achieved the highest accuracy.

Objective This study aims to systematically evaluate the evidence-based medicine of traditional Chinese medicine(TCM)in the treatment of dry eye,analyze its efficacy and differences compared with modern Western medicine treatments,and provide a scientific basis for clinical application.Methods By searching Chinese and English databases(including CNKI,Wanfang Data,PubMed,Cochrane Library,etc.),we included meta-analyses and systematic reviews of TCM treatments for dry eye.Literature was screened according to strict inclusion and exclusion criteria,and relevant data were extracted and integrated for analysis.The Mantel-Haenszel fixed-effects model was used to calculate the relative risk(RR)and mean difference(WMD),with the effect size expressed as a 95％confidence interval,to analyze the efficacy in-dicators of TCM treatment for dry eye.Results A total of 21 articles were finally included,involving various TCM inter-ventions for dry eye(such as Chinese herbal medicine,acupuncture,and TCM external therapies).The results showed that TCM treatment was superior to Western medicine alone in improving the overall clinical efficacy[RR=1.63,95％CI(1.46,1.81),P＜0.05],prolonging tear film break-up time[MD=2.23,95％CI(1.85,2.60),P＜0.05],and increasing tear secretion[MD=1.49,95％CI(1.04,1.94),P＜0.05].In addition,acupuncture,the combination of Chinese herbal medicine and Western medicine,and TCM external therapies all demonstrated unique advantages in improving dry eye symptoms and tear function.Conclusion TCM treatment for dry eye shows significant efficacy in key indicators such as overall clinical efficacy,tear film break-up time,and tear secretion,with a high level of safety.

Objective:To analyze the non-motor symptom characteristics of patients with different subtypes of progressive supranuclear palsy (PSP).Methods:Demographic data were collected from patients diagnosed with probable or possible PSP in the PSP cohort at Qilu Hospital of Shandong University from June 2019 to June 2023. Motor symptoms were evaluated using the Progressive Supranuclear Palsy Rating Scale (PSPRS), Unified Parkinson′s Disease Rating Scale-Ⅲ , and the Freezing of Gait Questionnaire. Non-motor symptoms were assessed using the Non-Motor Symptoms Scale (NMSS), the Montreal Cognitive Assessment, the Hamilton Depression Rating Scale, and the Hamilton Anxiety Rating Scale. Patients were grouped into PSP with Richardson syndrome (PSP-RS), PSP with Parkinsonism (PSP-P), PSP with progressive gait freezing (PSP-PGF), and other subtypes (PSP-other) based on clinical classification. The study compared the non-motor symptom characteristics among the 4 groups and used linear regression models to evaluate the influencing factors of PSP non-motor symptoms.Results:A total of 153 PSP patients were included in this study, with a male-to-female ratio of 89∶64 and an age of (66.0±6.6) years. Among them, 83 were in the PSP-RS group (54.2%), 32 in the PSP-P group (20.9%), 27 in the PSP-PGF group (17.6%), and 11 in the PSP-other group (7.2%). The total NMSS score for non-motor symptoms in PSP patients was 62.6±38.5, with 8.8±4.7 non-motor symptoms per patient. The most common non-motor symptoms among all PSP patients were sleep/fatigue [130/153 (85.0%)], gastrointestinal symptoms [129/153 (84.3%)], urinary symptoms [113/153 (73.9%)], attention/memory impairment [112/153 (73.2%)], and mood symptoms [108/153 (70.6%)]. The total NMSS score of the PSP-RS group (70.8±36.0) was higher than that of the PSP-PGF group (49.4±40.3; t=2.561, P=0.011). The number of non-motor symptoms in the PSP-RS group (9.9±4.4) was greater than that in the PSP-P group (7.7±5.5; t=2.365, P=0.019) and the PSP-PGF group (6.9±4.3; t=2.978, P=0.003). The incidence of memory decline in the PSP-RS group [52/83 (62.7%)] was higher than that in the PSP-P group [10/32 (31.3%); χ 2=9.165, Bonferroni-corrected P=0.012], and the incidence of constipation in the PSP-RS group [49/83 (59.0%)] was higher than that in the PSP-PGF group [8/27 (29.6%); χ 2=7.056, Bonferroni-corrected P=0.048]. Multivariate regression analysis showed that the bulbar symptom score ( β=5.591, 95% CI 1.792-9.389, P=0.005), limb motor score ( β=1.786, 95% CI 0.398-3.174, P=0.013), and gait/axial score ( β=1.956, 95% CI 0.149-3.763, P=0.036) in PSPRS were all associated with non-motor symptom scores. Conclusions:Different PSP subtypes exhibit distinct non-motor symptom profiles. PSP-RS patients bear a heavier non-motor symptom burden, with higher incidences of memory decline and constipation than other subtypes. These findings may aid in the early recognition and clinical diagnosis of PSP.

BACKGROUND:Long non-coding RNA(LncRNA)plays an important role in nervous system development and neurological diseases.Previous studies by the research team have demonstrated that human umbilical cord mesenchymal stem cells overexpressing erythropoietin(EPO-MSCs)under ischemic and hypoxic conditions have better neuroprotective functions and significantly activate the expression of LncRNA XIST.Research suggests that XIST is related to the pathogenesis of hypoxic-ischemic encephalopathy,but the role and mechanism of its regulation by EPO-MSCs in protecting ischemic-hypoxic neurons remain unclear.OBJECTIVE:To explore the new mechanism by which LncRNA XIST,in response to EPO-MSC signaling,affects the apoptosis of ischemic-hypoxic SH-SY5Y cells.METHODS:(1)SH-SY5Y cell lines with knockdown of LncRNA XIST(sh-XIST)and negative control(NC-XIST)were constructed through lentiviral transfection.Oxygen-glucose deprivation was used to induce ischemic-hypoxic injury in the cells.Transwell chambers were used to create a non-contact co-culture system with EPO-MSCs,sh-XIST,and NC-XIST ischemic-hypoxic SH-SY5Y cells.Cell proliferation ability was detected using the CCK-8 assay.Cell migration ability was assessed using the scratch assay,and cell apoptosis was measured by flow cytometry.(2)RNA-seq bioinformatics analysis was performed to screen for differentially expressed genes and pathways between sh-XIST and NC-XIST cell lines.Dual-luciferase experiments were used to verify the relationship between miR-124-3p and the target genes XIST and GRIN1.qRT-PCR was conducted to validate the expression levels of downstream miR-124-3p and GRIN1 genes.(3)miR-124-3p inhibitors and mimics were added to verify phenotypic changes in SH-SY5Y cells after ischemic-hypoxic injury and co-culture with EPO-MSCs.RESULTS AND CONCLUSION:(1)Compared with the NC-XIST group,SH-SY5Y cells in the sh-XIST group showed reduced proliferation and migration abilities and increased apoptosis after ischemic-hypoxic injury and co-culture with EPO-MSCs.(2)Dual-luciferase experiments showed that miR-124-3p interacted with the target gene XIST.SH-SY5Y cells transfected with miR-124-3p mimics and co-cultured with EPO-MSCs showed decreased apoptosis after ischemic-hypoxic injury,while SH-SY5Y cells transfected with miR-124-3p inhibitors showed increased apoptosis after co-culture with EPO-MSCs.(3)Transcriptomic sequencing and bioinformatics analysis of sh-XIST revealed significant downregulation of the neuroactive ligand-receptor pathway and the key receptor gene GRIN1 for central nervous system development.(4)Dual-luciferase experiments showed that miR-124-3p interacted with GRIN1.GRIN1 expression was significantly downregulated in the sh-XIST group after ischemic-hypoxic injury compared with the NC-XIST group.These findings indicate that LncRNA XIST promotes GRIN1 expression by upregulating miR-124-3p,thereby reducing cell apoptosis after ischemic-hypoxic injury and co-culture with EPO-MSCs and enhancing proliferation and migration.sh-XIST can block this protective function.

Objective:To examine the interaction between interpersonal issues and eating behavior problems among college freshmen, and to identify core psychological factors and potential pathways that drive eating behavior.Methods:In October 2019, a total of 5 073 college freshmen from a university in Shanghai were recruited as participants. Their general demographic data were collected, and they were evaluated using the eating disorder examination questionnaire 6.0 (EDE-Q 6.0) and inventory of interpersonal problems-32(IIP-32).Descriptive analyses were performed using SPSS 24.0 software.A regularized partial correlation network was constructed using the graphical least absolute shrinkage and selection operator (GLASSO) in R(v4.2.3) software. A Bayesian network analysis (BNA) was conducted to build a directed network, aiming to identify core driving factors and key psychological mechanisms.Results:Regularized partial correlation network identified shape concern as the most central node, with the highest strength centrality(1.32) and expected influence(1.20). It showed the highest bridge strength with dominance/control (0.22, 0.21), linking the interpersonal and eating behavior modules. Directed network analysis indicated that low self-confidence was the upstream node influencing social inhibition and cold/ distant relationships, indirectly affecting eating disorder.Within the eating module, shape concern and weight concern predicted eating preoccupation and dietary restraint, forming a pathway structure from eating cognition to behavior.The network demonstrated good stability (CS-coefficient=0.75).Conclusion:Shape concern is the core mechanism underlying eating problems in college freshmen. Low self-confidence contributes indirectly via interpersonal dysfunction. Dominance/control and shape concern bridge interpersonal and eating domains, providing key targets for early prevention and intervention.

Objective:To examine the interaction between interpersonal issues and eating behavior problems among college freshmen, and to identify core psychological factors and potential pathways that drive eating behavior.Methods:In October 2019, a total of 5 073 college freshmen from a university in Shanghai were recruited as participants. Their general demographic data were collected, and they were evaluated using the eating disorder examination questionnaire 6.0 (EDE-Q 6.0) and inventory of interpersonal problems-32(IIP-32).Descriptive analyses were performed using SPSS 24.0 software.A regularized partial correlation network was constructed using the graphical least absolute shrinkage and selection operator (GLASSO) in R(v4.2.3) software. A Bayesian network analysis (BNA) was conducted to build a directed network, aiming to identify core driving factors and key psychological mechanisms.Results:Regularized partial correlation network identified shape concern as the most central node, with the highest strength centrality(1.32) and expected influence(1.20). It showed the highest bridge strength with dominance/control (0.22, 0.21), linking the interpersonal and eating behavior modules. Directed network analysis indicated that low self-confidence was the upstream node influencing social inhibition and cold/ distant relationships, indirectly affecting eating disorder.Within the eating module, shape concern and weight concern predicted eating preoccupation and dietary restraint, forming a pathway structure from eating cognition to behavior.The network demonstrated good stability (CS-coefficient=0.75).Conclusion:Shape concern is the core mechanism underlying eating problems in college freshmen. Low self-confidence contributes indirectly via interpersonal dysfunction. Dominance/control and shape concern bridge interpersonal and eating domains, providing key targets for early prevention and intervention.

Objective:To investigate the impact of four registration methods on the accuracy of virtual occlusal records (VOR) in intraoral scanning for implant restorations with multiple missing teeth.Methods:A mandibular model simulating clinical conditions with multiple missing teeth (right first molar, left second premolar, left first molar, left second molar) and a maxillary compete dentition model were mounted on a semi-adjustable articulator. Subsequently, twelve 0.5 mm stainless steel spheres were adhered to reference positions (16, 46, 13, 43, 23, 33, 25, 35, 26, 36, 27, 37) as fiducial markers. Following this, a laboratory scanner generated reference datasets by digitizing the models in maximum intercuspation (MIP). Meanwhile, ten maxillary and mandibular scans were acquired using an intraoral scanner, with all nonarticulated scans duplicated four times to ensure data consistency. Forty VOR intraoral scans were performed in MIP using four registration protocols: left-side, right-side, anterior, and bilateral registration ( n=10 per group), randomized via a computer-generated pseudo-random sequence. For measurement, linear distances (D16-46, D13-43, D23-33, D25-35, D26-36, D27-37, D16-46 represented the single-tooth defect position, whereas D25-35, D26-36, D27-37 reflected positions in free-end edentulism areas) between opposing markers were measured in a reverse engineering software, with deviations (ΔD) from the reference scan calculated to assess accuracy. Specifically, negative ΔD values indicated vertical dimension underestimation. Given that non-normally distributed data were analyzed using medians [interquartile ranges (IQR)], trueness (median ΔD) and precision (IQR) were evaluated. The interaction effect between the registration method and the position of the measurement items was evaluated by using the generalized linear model. The accuracy was compared overall by the Kruskal-Wallis test with the two-sided significance level of α=0.05. For pairwise comparisons, post-hoc tests were conducted by Dunn′s t-test with the Bonferroni correction for the significance level. Results:The accuracy of VOR was affected by registration method ( P<0.05), with a significant position×registration method interaction observed ( P<0.05). In particular, in all four groups, only the bilateral registration group showed trueness of less than 0.1 mm for both free-end edentulism and the single tooth defect, with ΔD16-46, ΔD25-35, ΔD26-36, and ΔD27-37 being 0.059 (0.015), -0.082 (0.052), -0.065 (0.032), -0.070 (0.050) mm, respectively. Moreover, trueness in free-end edentulism showed negative values across all groups, with the largest negative deviations observed in the right-side registration group, with ΔD25-35, ΔD26-36 and ΔD27-37 being -0.410 (0.174), -0.442 (0.225), -0.439 (0.262) mm, respectively. Conclusions:In fully digital workflows of implant restorations for mandibular free-end edentulism with multiple missing teeth, registration method critically influences VOR accuracy. While four registration methods exhibited underestimation of occlusal vertical dimension, bilateral registration achieved the highest accuracy.

Objective This study aims to systematically evaluate the evidence-based medicine of traditional Chinese medicine(TCM)in the treatment of dry eye,analyze its efficacy and differences compared with modern Western medicine treatments,and provide a scientific basis for clinical application.Methods By searching Chinese and English databases(including CNKI,Wanfang Data,PubMed,Cochrane Library,etc.),we included meta-analyses and systematic reviews of TCM treatments for dry eye.Literature was screened according to strict inclusion and exclusion criteria,and relevant data were extracted and integrated for analysis.The Mantel-Haenszel fixed-effects model was used to calculate the relative risk(RR)and mean difference(WMD),with the effect size expressed as a 95％confidence interval,to analyze the efficacy in-dicators of TCM treatment for dry eye.Results A total of 21 articles were finally included,involving various TCM inter-ventions for dry eye(such as Chinese herbal medicine,acupuncture,and TCM external therapies).The results showed that TCM treatment was superior to Western medicine alone in improving the overall clinical efficacy[RR=1.63,95％CI(1.46,1.81),P＜0.05],prolonging tear film break-up time[MD=2.23,95％CI(1.85,2.60),P＜0.05],and increasing tear secretion[MD=1.49,95％CI(1.04,1.94),P＜0.05].In addition,acupuncture,the combination of Chinese herbal medicine and Western medicine,and TCM external therapies all demonstrated unique advantages in improving dry eye symptoms and tear function.Conclusion TCM treatment for dry eye shows significant efficacy in key indicators such as overall clinical efficacy,tear film break-up time,and tear secretion,with a high level of safety.