BackgroundPersistent cognitive impairment is prevalent among patients with stable schizophrenia. While serum total bile acid （TBA） level in acute-phase patients are known to be associated with cognitive dysfunction， the relationship between serum TBA and multi-dimensional cognitive functions in stable phase patients remains unclear. ObjectiveTo investigate the correlation between serum TBA level and cognitive function in patients with stable schizophrenia， and to evaluate its predictive value for cognitive impairment， thereby providing a serological biomarker for the timely identification and objective assessment of cognitive dysfunction. MethodsA cross-sectional study was conducted on 137 inpatients with stable schizophrenia at The Fourth People's Hospital of Yancheng from March to December 2024. All participants met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. Cognitive function was evaluated using the Chinese Brief Cognitive Test （C-BCT）， patients were categorized into four groups： normal cognition （n=28）， mild impairment （n=28）， moderate impairment （n=47）， and severe impairment （n=34）. Fasting venous blood samples were collected， and serum TBA level was quantified using an enzymatic cycle assay. Spearman correlation analysis was ultilized to determine the relationship between serum TBA level， overall cognitive function， and specific cognitive domains. Binary Logistic regression model was used （adjusting for covariates such as age， gender， and disease duration） to analyze the impact of serum TBA level on overall and individual cognitive functions. The predictive value of serum TBA level for overall cognitive impairment was evaluated using receiver operating characteristic （ROC） curve. ResultsSerum TBA levels differed significantly among the four groups （H=18.677， P<0.01）. Specifically， serum TBA levels in both the moderate and severe cognitive impairment groups were significantly higher than those in the normal cognitive group （adjusted P<0.01）. Serum TBA level was positively correlated with the severity grading of overall cognitive impairment （r_s=0.354， P<0.05）， and negatively correlated with T-scores on the trail making test （r_s=-0.328， P<0.05）， continuous performance test （r_s=-0.247， P<0.05）， digit span （r_s=-0.265， P<0.05）， and symbol coding （r_s=-0.221， P<0.05）. Binary Logistic regression analysis identified serum TBA level as an independent risk factor for overall cognitive impairment （OR=1.322， 95% CI： 1.021 - 1.713， P=0.034）， with a particularly robust predictive ability for impaired information processing speed （OR=1.325， 95% CI： 1.057 - 1.661， P=0.015）. The area under ROC curve （AUC） for serum TBA level in predicting overall cognitive impairment was 0.738， with a sensitivity of 60.61% and a specificity of 78.64%. ConclusionIn patients with stable schizophrenia， elevated serum TBA levels are associated with worse overall cognitive function， as well as deficits in information processing speed， attention， working memory， and executive function. Serum TBA serves as an independent risk factor and exhibits moderate predictive value for overall cognitive impairmen，particularly in the domain of information processing speed. ［Funded by Yancheng Municipal Health Commission Medical Research Project （number， YK2024141）］

Objective: To investigate the incidence of postoperative neurological complications among patients who underwent spinal deformity surgery and to determine the significant risk factors for postoperative neurological complications. Methods: Six databases PubMed, Web of Science, Scopus, MEDLINE, Embase, and Cochrane Library have been searched to identify observational studies from inception until January 2025. Inclusion criteria were patients aged ≥10 years with postoperative neurological complications after spinal deformity surgery. Stata/MP18.0 was used to conduct the meta-analysis in this review. The summary incidence estimates, proportion with 95% confidence intervals (CIs) and weights were pooled by the random-effects restricted maximum likelihood model. Results: The search strategy identified 53 articles with 40,958 patients for final review. Overall incidence of postoperative neurological complications was 7% (95% CI, 5.0%–9.0%; p < 0.001; I2 = 98.34%) in which incidence estimates for patients with adult spinal deformity and underwent 3-column spinal osteotomies were 12% (95% CI, 9%–16%; p < 0.001; I2 = 93.17%) and 18% (95% CI, 8%–31%; p < 0.001; I2 = 94.68%) respectively. Preoperative neurological deficit was the risk factor with highest overall odds ratio (OR, 2.86; 95% CI, 1.85–4.41; p = 0.01; I2 = 76.20%), followed by the presence of kyphosis (OR, 1.13; 95% CI, 0.75–1.70; p = 0.02; I2 = 81.80%) and age at surgery (OR, 1.04; 95% CI, 1.01–1.08; p = 0.04; I2 = 68.80%). Conclusion Preoperative neurological deficit, the presence of kyphosis and age at surgery were significant risk factors for postoperative neurological complications. Therefore, comprehensive preoperative assessment and surgical planning are crucial to minimize the risk of developing postoperative neurological complications or the deterioration of pre-existing neurologic deficits.

Methods: Patients with Lenke 1 AIS undergoing posterior spinal fusion were included. Standing and fulcrum bending radiographs on the coronal and sagittal planes were analyzed at preoperative, immediate, and 2-year postoperative periods. The primary outcome was postoperative hypokyphosis (T5–12 thoracic kyphosis [TK] <20°). Risk factors for postoperative hypokyphosis were identified by multivariate logistic regression, and the optimal cutoff for significant risk factors was determined by receiver operating characteristic analysis. Results: In total, 156 patients were included in the analysis, of which 68 (43.6%) were hypokyphotic at 2-year follow-up. Low T5–12 TK on lateral view fulcrum bending films (immediate postoperative odds ratio [OR], 0.870; 95% confidence interval [CI], 0.826–0.917; 2-year postoperative OR, 0.916; 95% CI, 0.876–0.959; p<0.001) and high convex side implant density (2-year postoperative OR, 1.749; 95% CI, 1.056–2.897; p=0.03) were significant risk factors for postoperative hypokyphosis. Other baseline demographic and surgical factors did not affect postoperative kyphosis correction. The T5–12 TK cutoff on fulcrum bending for 2-year postoperative hypokyphosis was 12.45° (area under the curve, 0.773; 95% CI, 0.661–0.820). Conclusions Fulcrum bending radiography is useful in assessing coronal and sagittal flexibility for preoperative planning. In patients with T5–12 kyphosis <12.5° on lateral view fulcrum bending radiographs, Ponte osteotomies or releases, or a decrease in convex side implant density should be considered to improve kyphosis restoration and reduce the risk of 2-year postoperative hypokyphosis.

Objective To identify potential quality risks of Xiaoer Huatan Zhike Granules(Pediatric Phlegm-Resolving and Cough-Relieving Granules)through National Drug Sampling and Inspection,evaluate their overall quality,and propose improvements to the quality standards.Methods Samples from 34 manufacturers were tested using official standards.Exploratory methods were developed to enhance risk analysis,including thin-layer chromatography(TLC)identification,content uniformity testing,quantitative assays,and screening for unauthorized additives(e.g.,colorants).Results All batches met the official standards(100.0%compliance rate).However,deficiencies were observed:most manufacturers lacked controls for ephedrine hydrochloride content uniformity and quantification,omitted key ingredient identifications(e.g.,herbal components),and exhibited insufficient TLC specificity(e.g.,TLC of Ipecac tincture showed only one spot instead of multiple alkaloid-specific spots).Exploratory studies revealed risks in total emetine/cephaeline content,morroniside A/platycodin D content,ephedrine hydrochloride uniformity,and unauthorized colorant addition.Conclusions The overall quality of this variety is good,but the enterprise should improve the quality control measures throughout the entire process and establish stricter internal control standards;The official standards,unchanged for approximately 30 years,fail to address current regulatory requirements.The statutory quality standards need to be revised and improved.Qualitative or quantitative indicators for all drug flavors in the prescription should be added,and the content uniformity inspection of ephedrine hydrochloride should be increased.

Objective:To investigate the pain intensity,location and relationship between pain and foot-ankle function in patients with functional ankle instability(FAI).Method:From September 2022 to July 2023,163 FAI patients were assessed at Beijing Tongren Hospital,with ankle pain location,pain intensity(visual analogue scale,VAS),and foot-ankle function(American or-thopedic foot and ankle society ankle and hindfoot score,AOFAS)scores recorded.The VAS and AOFAS of various pain locations and the number of pain locations was compared across groups.Multiple linear regression was used to examine the association between the number of pain locations,VAS,and AOFAS.Result:Out of 163 FAI patients,150 reported the pain.Among them,37.33％had pain in a single location,34％in two locations,and 28.67％in multiple locations(＞2).The most common pain locations were the sinus tarsi(32％)and the anterior talofibular ligament(31％).There were no significant differences in VAS and AO-FAS among different pain locations in FAI patients with the same number of pain locations(P＞0.05).The VAS of FAI patients with multi-location pain(＞2 regions)was higher than that of patients with single-loca-tion pain and 2-location pain(P＜0.01),whereas the AOFAS was lower(P＜0.05).The number of pain loca-tions and VAS were negatively correlated with AOFAS score(P＜0.05),which could predict 20.9％of the AO-FAS score.Conclusion:The majority of FAI patients experience pain,and the pain intensity and number of pain loca-tions impact foot and ankle function.When establishing and implementing rehabilitation strategies for FAI pa-tients,pain relief and minimizing the number of pain locations should be emphasized.Future research should investigate effective pain management measures to improve ankle function in patients with FAI at specific loca-tions with a high incidence(e.g.,tarsal sinus,anterior talofibular ligament).

Objective To analyze the risk factors for increased drainage volume after open transforaminal lumbar interbody fusion(TLIF),and to establish a predictive model and then validate it.Methods The clinical data of 680 patients who underwent open TLIF at the General Hospital of Northern Theater Command from January 2016 to December 2019 were collected and the patients were randomly divided into the training group(n=476)and the validation group(n=204).Taking the predictive factors screened out by LASSO regression analysis as independent variables,a multivariate Logistic regression predictive model was constructed.The model was internally validated through the receiver operating characteristic(ROC)curve,Hosmer-Lemeshow goodness-of-fit test,and calibration curve,and its clinical utility was assessed via decision curve analysis(DCA).Results LASSO regression analysis screened out four predictive variables:age,number of surgical segments,operative duration,and intraoperative blood loss.The multivariate Logistic regression predictive model demonstrated that age≥60 years,number of surgical segments≥4,operative duration≥2 hours,and intraoperative blood loss≥200 mL were independent influencing factors for the increased postoperative drainage volume in patients undergoing TLIF(P<0.05).ROC curve analysis revealed an area under the curve(AUC)of 0.816(95%CI:0.798 to 0.867)in the training group and 0.783(95%CI:0.685 to 0.823)in the validation group,indicating that the predictive model had good discriminatory ability.Additionally,the Hosmer-Lemeshow goodness-of-fit test and calibration curve indicated that the predictive model had a good degree of fit,and the predicted probability was basically consistent with the actual probability,demonstrating a good calibration.The DCA results confirmed that this predictive model could be applied in clinical practice.Conclusion The risk factors for increased drainage volume after open TLIF include age,number of surgical segments,operative duration,and intraoperative blood loss.The predictive model established based on these factors demonstrates good performance,and it can be applied in clinical guidance for the selection of drainage tube removal time after TLIF.

BACKGROUND:Studies have found that crocin can inhibit the apoptosis of osteoarthritis chondrocytes,reduce the inflammatory response of osteoarthritis rats,promote bone formation and inhibit bone loss in osteoporotic rats,and has great application potential in cartilage and bone damage.OBJECTIVE:To observe the effects of crocin hydrogel on chondrocytes and MC3T3-E1 cells.METHODS:Crocin hydrogels were prepared by Schiff base crosslinking method by adding different concentrations of crocin solution(0,15,20,and 25 mmol/L)into oxidized hyaluronic acid-oxidized chondroitin sulfate-type Ⅱ collagen mixed solution,and then four kinds of hydrogel extracts were prepared.Human chondrocytes were cultured with four kinds of crocin hydrogel extracts to detect glycosaminoglycan synthesis.Cell proliferation was detected by CCK-8 assay.Cell migration was detected by Transwell chamber assay.RT-qPCR was used to detect the mRNA expression of SOX9,type Ⅱ collagen,and aggrecan in cells.Four kinds of crocin hydrogel extracts were co-cultured with MC3T3-E1 cells,respectively.Cell proliferation was detected by CCK-8 assay.RT-qPCR was used to detect the mRNA expression of RUNX2,type Ⅰ collagen,alkaline phosphatase,and osteocalcin in cells.and the alkaline phosphatase activity and mineralized nodule formation after osteogenic differentiation.RESULTS AND CONCLUSION:(1)CCK-8 assay results showed that 15 and 20 mmol/L crocin hydrogel extract promoted the proliferation of chondrocytes,while 25 mmol/L crocin hydrogel extract inhibited the proliferation of chondrocytes.15,20,and 25 mmol/L crocin hydrogel extracts could all promote the migration of chondrocytes,increase the expression of SOX9,type Ⅱ collagen,aggrecan mRNA and glycosaminoglycan synthesis of chondrocytes in a dose-dependent manner.(2)15,20,and 25 mmol/L crocin hydrogel extract could promote the proliferation of MC3T3-E1 cells and increase the expression of RUNX2,type Ⅰcollagen,alkaline phosphatase,and osteocalcin mRNA in cells after osteogenic differentiation in a dose-dependent manner.15,20,and 25 mmol/L crocin hydrogel extract could increase the alkaline phosphatase activity and mineralized nodule formation of MC3T3-E1 cells after osteogenic induction differentiation.Among them,20 mmol/L crocin hydrogel extract is the most significant in improvement effect of the extract liquid.(3)The results show that crocin hydrogel can promote the proliferation and migration of chondrocytes and the synthesis of cartilage extracellular matrix,and enhance the proliferation and osteogenic differentiation of MC3T3-E1 cells.Among them,the comprehensive effect of 20 mmol/L crocin hydrogel is best.

Objective:To investigate the pain intensity,location and relationship between pain and foot-ankle function in patients with functional ankle instability(FAI).Method:From September 2022 to July 2023,163 FAI patients were assessed at Beijing Tongren Hospital,with ankle pain location,pain intensity(visual analogue scale,VAS),and foot-ankle function(American or-thopedic foot and ankle society ankle and hindfoot score,AOFAS)scores recorded.The VAS and AOFAS of various pain locations and the number of pain locations was compared across groups.Multiple linear regression was used to examine the association between the number of pain locations,VAS,and AOFAS.Result:Out of 163 FAI patients,150 reported the pain.Among them,37.33％had pain in a single location,34％in two locations,and 28.67％in multiple locations(＞2).The most common pain locations were the sinus tarsi(32％)and the anterior talofibular ligament(31％).There were no significant differences in VAS and AO-FAS among different pain locations in FAI patients with the same number of pain locations(P＞0.05).The VAS of FAI patients with multi-location pain(＞2 regions)was higher than that of patients with single-loca-tion pain and 2-location pain(P＜0.01),whereas the AOFAS was lower(P＜0.05).The number of pain loca-tions and VAS were negatively correlated with AOFAS score(P＜0.05),which could predict 20.9％of the AO-FAS score.Conclusion:The majority of FAI patients experience pain,and the pain intensity and number of pain loca-tions impact foot and ankle function.When establishing and implementing rehabilitation strategies for FAI pa-tients,pain relief and minimizing the number of pain locations should be emphasized.Future research should investigate effective pain management measures to improve ankle function in patients with FAI at specific loca-tions with a high incidence(e.g.,tarsal sinus,anterior talofibular ligament).

BACKGROUND:Studies have found that crocin can inhibit the apoptosis of osteoarthritis chondrocytes,reduce the inflammatory response of osteoarthritis rats,promote bone formation and inhibit bone loss in osteoporotic rats,and has great application potential in cartilage and bone damage.OBJECTIVE:To observe the effects of crocin hydrogel on chondrocytes and MC3T3-E1 cells.METHODS:Crocin hydrogels were prepared by Schiff base crosslinking method by adding different concentrations of crocin solution(0,15,20,and 25 mmol/L)into oxidized hyaluronic acid-oxidized chondroitin sulfate-type Ⅱ collagen mixed solution,and then four kinds of hydrogel extracts were prepared.Human chondrocytes were cultured with four kinds of crocin hydrogel extracts to detect glycosaminoglycan synthesis.Cell proliferation was detected by CCK-8 assay.Cell migration was detected by Transwell chamber assay.RT-qPCR was used to detect the mRNA expression of SOX9,type Ⅱ collagen,and aggrecan in cells.Four kinds of crocin hydrogel extracts were co-cultured with MC3T3-E1 cells,respectively.Cell proliferation was detected by CCK-8 assay.RT-qPCR was used to detect the mRNA expression of RUNX2,type Ⅰ collagen,alkaline phosphatase,and osteocalcin in cells.and the alkaline phosphatase activity and mineralized nodule formation after osteogenic differentiation.RESULTS AND CONCLUSION:(1)CCK-8 assay results showed that 15 and 20 mmol/L crocin hydrogel extract promoted the proliferation of chondrocytes,while 25 mmol/L crocin hydrogel extract inhibited the proliferation of chondrocytes.15,20,and 25 mmol/L crocin hydrogel extracts could all promote the migration of chondrocytes,increase the expression of SOX9,type Ⅱ collagen,aggrecan mRNA and glycosaminoglycan synthesis of chondrocytes in a dose-dependent manner.(2)15,20,and 25 mmol/L crocin hydrogel extract could promote the proliferation of MC3T3-E1 cells and increase the expression of RUNX2,type Ⅰcollagen,alkaline phosphatase,and osteocalcin mRNA in cells after osteogenic differentiation in a dose-dependent manner.15,20,and 25 mmol/L crocin hydrogel extract could increase the alkaline phosphatase activity and mineralized nodule formation of MC3T3-E1 cells after osteogenic induction differentiation.Among them,20 mmol/L crocin hydrogel extract is the most significant in improvement effect of the extract liquid.(3)The results show that crocin hydrogel can promote the proliferation and migration of chondrocytes and the synthesis of cartilage extracellular matrix,and enhance the proliferation and osteogenic differentiation of MC3T3-E1 cells.Among them,the comprehensive effect of 20 mmol/L crocin hydrogel is best.

Objective: Patients with severe symptomatic aortic stenosis are assessed for coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) with treatment implications. Invasive coronary angiography (ICA) is the recommended modality but is associated with peri-procedural complications. Integrating machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) into existing TAVI-planning CT protocol may aid exclusion of significant CAD and thus avoiding ICA in selected patients. Materials and Methods: A single-center, retrospective study was conducted, 41 TAVI candidates with both TAVI-planning CT and ICA performed were analyzed. CT datasets were evaluated by a ML-based CT-FFR software. Beta-blocker and nitroglycerin were not administered in these patients. The primary outcome was to identify significant CAD. The diagnostic performance of CT-FFR was compared against ICA. Results: On per-patient level, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 89%, 94%, 80%, 97% and 93%, respectively. On per-vessel level, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 75%, 94%, 67%, 96% and 92%, respectively. The area under the receiver operative characteristics curve per individual coronary vessels yielded overall 0.90 (95% confidence interval 85%–95%). ICA may be avoided in up to 80% of patients if CT-FFR results were negative. Conclusion ML-based CT-FFR can provide accurate screening capabilities for significant CAD thus avoiding ICA. Its integration to existing TAVI-planning CT is feasible with the potential of improving the safety and efficiency of pre-TAVI CAD assessment.