Objective To compare the effect of transcranial direct current stimulation(tDCS)combined with seated Taijiquan Yun-shou in different sequences on brain functional activation in healthy youths.Methods From September to December,2024,14 healthy young medical interns or probationers were recruited from the Fifth Hospital of Xiamen.They randomly completed three interventions in a crossover design:Yunshou training followed immediately by tDCS(Y-S group),tDCS intervention followed immediately by Yunshou training(S-Y group),and simultaneous implementation of tDCS intervention and Yunshou training(Sim group).Yunshou was practiced in a seated position.For tDCS,the anode was placed over the left primary motor cortex(M1),and the cathode over the right M1.Changes in oxyhemoglobin(HbO2)concentration in the regions of interest were mea-sured using functional near-infrared spectroscopy.Results Three cases dropped down.The brain regions with significant differences before and after intervention included:CH3,CH7 and CH23 of right prefrontal cortex(PFC)in Y-S group;CH12 of left PFC in S-Y group;and CH9,CH10 and CH25 of the left PFC,CH13 and CH14 of the left sensorimotor cortex(SMC),CH15 of the right pre-motor and supplementary motor cortex(PMC),and CH16 of the right SMC in Sim group(P<0.05).After inter-vention,HbO2 concentration was the highest in the bilateral PFC,bilateral PMC and left SMC in the Y-S group(P<0.05);and it was almost the same between Sim group and S-Y group(P>0.05),except that of the right PFC decreased in Sim group.Conclusion The sequential combination of brain-limb integrated regulation is a key factor influencing the immediate cor-tical activation pattern.

Objective:To evaluate the predictive efficacy of multiple MRI radiomics-based machine learning models for the prognosis of patients with traumatic cervical spinal cord injury.Methods:A retrospective cohort study was conducted to analyze the plain cervical MRI imaging data of 135 patients with traumatic cervical spinal cord injury admitted to the Ninth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to January 2024, including 107 males and 28 females, aged 24-89 years [(56.0±11.9)years]. The patients were randomly divided into training group ( n=94) and test group ( n=41) at a ratio of 7∶3. According to the Japanese Orthopedic Association (JOA) score, 56 patients had no self-care ability (0-8 points), while 79 patients had self-care ability (9-17 points). The cervical spinal cord injury areas of all the patients were delineated. After standardizing the signal intensity distribution of the images using Z-Score, the radiomics features of the injury areas were extracted, on which the dimensionality reduction was performed by the Pearson correlation coefficient method. In the training group, the Lasso regression model was used to screen the radiomics features significantly related to the prognosis of no self-care ability and the features were then input into seven classifiers to construct prediction models, including the support vector machine, random forest, extremely randomized tree, light gradient boosting machine, adaptive boosting, naive Bayes, and K nearest neighbor. In the test group, the predictive performance of each model was evaluated through accuracy, sensitivity, specificity, precision, F1 score, area under the receiver operating characteristic (ROC) curve (AUC), and Hosmer-Lemeshow (H-L) goodness-of-fit test. The clinical applicability of each model was evaluated through clinical decision curve analysis (DCA). Results:A total of 14 radiomics features were selected, including 1 first-order feature and 13 texture features. In the test group, the accuracy rates of the 7 models of support vector machine, random forest, extremely randomized tree, light gradient boosting machine, adaptive boosting, naive Bayes, and K nearest neighbor were 0.85, 0.81, 0.90, 0.90, 0.71, 0.73 and 0.71, respectively; the precision rates were 1.00, 0.95, 0.92, 0.96, 0.72, 0.75 and 0.88, respectively; the sensitivity rates were 0.76, 0.72, 0.92, 0.88, 0.84, 0.84 and 0.60, respectively; the specificity rates were 1.00, 0.94, 0.88, 0.94, 0.50, 0.56 and 0.88, respectively; the F1 scores were 0.86, 0.82, 0.92, 0.92, 0.78, 0.79 and 0.71, respectively; the AUC values were 0.93, 0.92, 0.94, 0.97, 0.58, 0.67 and 0.88, respectively; the P values of the H-L goodness-of-fit test were 0.211, 0.112, 0.218, 0.089,<0.001,<0.001 and 0.105, respectively; the DCA results indicated that the support vector machine exhibited a clinical benefit rate greater than 0 within the 0-1 interval, surpassing the performance of the other models. Conclusions:Four MRI radiomics-based models, including support vector machine, random forest, extremely randomized tree, and light gradient boosting machine, have good predictive efficacy for the prognosis of patients with traumatic cervical spinal cord injury. Among them, the support vector machine model has the best clinical applicability.

Objective To compare the effect of transcranial direct current stimulation(tDCS)combined with seated Taijiquan Yun-shou in different sequences on brain functional activation in healthy youths.Methods From September to December,2024,14 healthy young medical interns or probationers were recruited from the Fifth Hospital of Xiamen.They randomly completed three interventions in a crossover design:Yunshou training followed immediately by tDCS(Y-S group),tDCS intervention followed immediately by Yunshou training(S-Y group),and simultaneous implementation of tDCS intervention and Yunshou training(Sim group).Yunshou was practiced in a seated position.For tDCS,the anode was placed over the left primary motor cortex(M1),and the cathode over the right M1.Changes in oxyhemoglobin(HbO2)concentration in the regions of interest were mea-sured using functional near-infrared spectroscopy.Results Three cases dropped down.The brain regions with significant differences before and after intervention included:CH3,CH7 and CH23 of right prefrontal cortex(PFC)in Y-S group;CH12 of left PFC in S-Y group;and CH9,CH10 and CH25 of the left PFC,CH13 and CH14 of the left sensorimotor cortex(SMC),CH15 of the right pre-motor and supplementary motor cortex(PMC),and CH16 of the right SMC in Sim group(P<0.05).After inter-vention,HbO2 concentration was the highest in the bilateral PFC,bilateral PMC and left SMC in the Y-S group(P<0.05);and it was almost the same between Sim group and S-Y group(P>0.05),except that of the right PFC decreased in Sim group.Conclusion The sequential combination of brain-limb integrated regulation is a key factor influencing the immediate cor-tical activation pattern.

Objective:To observe the safety and short-term efficacy of using an autologous fascia lata sling (AFLS) for tension-free mid-urethral sling (MUS) in the treatment of stress urinary incontinence (SUI).Methods:Between February 2022 and December 2023, 11 patients with SUI underwent AFLS-MUS. Preoperative data were recorded, including basic patient information and completion of urinary distress inventory 6 (UDI-6). During surgery, AFLS was harvested through a small incision using a tendon extractor, and used as a sling for transobturator or retropubic MUS. Perioperative indicators were recorded, including surgical approach, operation time, intraoperative blood loss, postoperative hospital stay, duration of catheterization, perioperative complications (Clavien-Dindo classification), and surgical costs. Follow-ups included outpatient physical examination at 2 months postoperatively, and telephone follow-up at 6 months, 1 year, and annually thereafter. Follow-up content included the presence or absence of urinary leakage symptoms, UDI-6, satisfaction, patient global impression of improvement (PGI-I), and complications.Results:The age of the 11 patients was (54.8±10.9) years (range: 41-72 years), with body mass index of (23.9±1.8) kg/m2 (range: 21.4-27.3 kg/m2). All patients experienced urinary leakage after coughing, sneezing and physical activity, with positive SUI provocation tests. The preoperative UDI-6 was 50.0±21.6 (range: 16.7-79.2), the result of 1-hour pad test was (18.9±12.0) g (range: 2.5-71.2 g). Four cases underwent MUS only, with operation time of (98.0±13.3) minutes (range: 86-117 minutes), and intraoperative blood loss of (17.5±5.0) ml (range: 10-20 ml); 7 cases also underwent pelvic floor repair simultaneously. The postoperative hospital stay was (3.5±2.0) days (range: 2-9 days). The duration of catheterization was (4.5±3.8) days (range: 2-11 days), with postoperative urinary retention in three cases, one of which underwent sling release surgery due to severe postoperative voiding difficulty 1 week after MUS, with no other complications of Clavien-Dindo grade 2 or above. The cost of AFLS harvest plus MUS was (2 762±293) yuan. At the 2-month outpatient follow-up, all patients were free of urinary leakage symptoms, with UDI-6 of 2.3±1.9 (range: 0-8.3); satisfaction was "very satisfied" in 10 cases and "fairly satisfied" in 1 case, with PGI-I all being "much better", and pelvic examinations were normal. Telephone follow-up showed one case lost to follow-up, and the remaining 10 cases had follow-up time of (18.6±4.9) months (range: 7-26 months), all without urinary leakage, with UDI-6 of 2.7±2.6, satisfaction rated as "very satisfied", and PGI-I all "much better".Conclusion:This modified AFLS-MUS for the treatment of SUI shows good short-term efficacy and high safety in harvest site, with the need for more data accumulation and long-term follow-up.

Objective:To evaluate the predictive efficacy of multiple MRI radiomics-based machine learning models for the prognosis of patients with traumatic cervical spinal cord injury.Methods:A retrospective cohort study was conducted to analyze the plain cervical MRI imaging data of 135 patients with traumatic cervical spinal cord injury admitted to the Ninth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to January 2024, including 107 males and 28 females, aged 24-89 years [(56.0±11.9)years]. The patients were randomly divided into training group ( n=94) and test group ( n=41) at a ratio of 7∶3. According to the Japanese Orthopedic Association (JOA) score, 56 patients had no self-care ability (0-8 points), while 79 patients had self-care ability (9-17 points). The cervical spinal cord injury areas of all the patients were delineated. After standardizing the signal intensity distribution of the images using Z-Score, the radiomics features of the injury areas were extracted, on which the dimensionality reduction was performed by the Pearson correlation coefficient method. In the training group, the Lasso regression model was used to screen the radiomics features significantly related to the prognosis of no self-care ability and the features were then input into seven classifiers to construct prediction models, including the support vector machine, random forest, extremely randomized tree, light gradient boosting machine, adaptive boosting, naive Bayes, and K nearest neighbor. In the test group, the predictive performance of each model was evaluated through accuracy, sensitivity, specificity, precision, F1 score, area under the receiver operating characteristic (ROC) curve (AUC), and Hosmer-Lemeshow (H-L) goodness-of-fit test. The clinical applicability of each model was evaluated through clinical decision curve analysis (DCA). Results:A total of 14 radiomics features were selected, including 1 first-order feature and 13 texture features. In the test group, the accuracy rates of the 7 models of support vector machine, random forest, extremely randomized tree, light gradient boosting machine, adaptive boosting, naive Bayes, and K nearest neighbor were 0.85, 0.81, 0.90, 0.90, 0.71, 0.73 and 0.71, respectively; the precision rates were 1.00, 0.95, 0.92, 0.96, 0.72, 0.75 and 0.88, respectively; the sensitivity rates were 0.76, 0.72, 0.92, 0.88, 0.84, 0.84 and 0.60, respectively; the specificity rates were 1.00, 0.94, 0.88, 0.94, 0.50, 0.56 and 0.88, respectively; the F1 scores were 0.86, 0.82, 0.92, 0.92, 0.78, 0.79 and 0.71, respectively; the AUC values were 0.93, 0.92, 0.94, 0.97, 0.58, 0.67 and 0.88, respectively; the P values of the H-L goodness-of-fit test were 0.211, 0.112, 0.218, 0.089,<0.001,<0.001 and 0.105, respectively; the DCA results indicated that the support vector machine exhibited a clinical benefit rate greater than 0 within the 0-1 interval, surpassing the performance of the other models. Conclusions:Four MRI radiomics-based models, including support vector machine, random forest, extremely randomized tree, and light gradient boosting machine, have good predictive efficacy for the prognosis of patients with traumatic cervical spinal cord injury. Among them, the support vector machine model has the best clinical applicability.

Objective:To evaluate the mediating effect of electrocardiographic (ECG) indicators in the association between short-term exposure to fine particulate matter (PM 2.5) and blood pressure and to explore the key PM 2.5 element constituents that produce the mediating effect. Methods:Based on a cross-sectional survey across 10 cities in the Beijing-Tianjin-Hebei region and surrounding areas, PM 2.5 and its element constituents were collected from the nearest air monitoring superstation. Blood pressure and ECG indicators of participants were obtained through physical examinations. A multivariate linear regression was used to evaluate the effect of short-term exposures to PM 2.5 on blood pressure. A mediation analysis was used to identify the mediating effect of ECG indicators in the association between exposure to PM 2.5 and its element constituents and blood pressure. Results:The age of the 1 793 participants was (65.1±13.3) years, and 885 (49.4%) were males. During the study period, the daily mean concentration of PM 2.5 was (70±45) μg/m 3, and the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP) were (139±20), (82±11), (101±13), and (57±17) mmHg (1 mmHg=0.133 kPa), respectively. The results of the multivariate linear regression showed that for every 10 μg/m 3 increase in PM 2.5 on the same day (lag 0), DBP increased by 0.15 (95% CI: 0.02-0.28) mmHg, and PP decreased 0.18 (95% CI: 0.36-0.01) mmHg. The exposure to 14 elemental constituents, such as Ga, Co and Se, was associated with an increase in DBP, while the exposure to 17 elemental constituents, such as Cs, Se and Ag, was associated with a decrease in PP. At lag 0, the PM 2.5-induced increase in DBP was mediated by the QRS interval (mediation percentage of 18.98%), and the PM 2.5-induced decrease in PP was mediated by the QT interval (mediation percentage of -6.31%). The exposure to K, Br, Pb, Zn, Ca, Co, Pd, Cu, and As constituents was associated with increases in DBP mediated by prolonged QRS interval. The exposure to Pb, Zn, K, and As constituents was associated with decreases in PP mediated by prolonged QRS interval. Conclusion:ECG indicators such as QRS interval may mediate the association between short-term exposure to PM 2.5 and its element constituents and blood pressure.

Objective:To investigate the correlation between the expression of hepatoma-derived growth factor (HDGF) and the prognosis of patients with oral cancer.Methods:Clinical data of 96 patients with oral cancer admitted to Nanjing Tongren Hospital, School of Medicine, Southeast University from March 2019 to January 2023 were retrospectively analyzed, and biopsy cancer tissue specimens and adjacent tissues >3 cm from the tumor margin of oral cancer patients were collected. The expression of HDGF in cancer tissues and adjacent tissues was compared, and the influence of HDGF expression on prognosis of patients was analyzed. The patients were followed up for 36 months to compare the survival rate of patients with HDGF-negative and HDGF-positive oral cancer during follow-up.Results:The positive expression rate of HDGF in oral cancer tissues [75.00%(72/96)] was higher than that in adjacent tissues [11.46%(11/96)] ( P<0.05). There was no significant difference in the positive expression rate of HDGF in oral cancer patients with different sex, age, body mass index (BMI), smoking and drinking conditions ( P>0.05). The positive expression rate of HDGF in oral cancer tissues of patients with tumor length ≥3 cm, clinical stage Ⅲ-Ⅳ, lymph node metastasis, low differentiation, and vascular invasion was higher than that of patients with tumor length <3 cm, clinical stageⅠ-Ⅱ, no lymph node metastasis, medium/high differentiation, and no vascular invasion (all P<0.05). Cox regression analysis showed that tumor length, periodontitis or pulpitis, smoking, clinical stage, lymph node metastasis, histological type and positive expression of HDGF were independent influencing factors for overall survival of patients with oral cancer (all P<0.05). By the end of follow-up, the overall survival rate of patients with positive expression of HDGF was 70.77%(46/65), and that of patients with negative expression of HDGF was 95.45%(21/22). The survival rate of patients with negative expression of HDGF was higher than that of patients with positive expression ( P<0.05). Conclusions:The expression of HDGF in oral cancer tissues is abnormally high, which is closely related to clinicopathological features and prognosis.

Objective:To analyze the association between inflammation-related dietary patterns and the risk for cognitive impairment in older adults aged ≥65 years in longevity areas in China by using reduced rank regression (RRR) analysis.Methods:This study used cross-sectional data from the 2021 Healthy Aging and Biomarkers Cohort Study, including the information about study participants' demographic characteristics, lifestyles, daily life activities, and disease histories. Dietary intake was obtained by using a simplified food frequency questionnaire. Cognitive impairment was evaluated based on the Mini-Mental State Examination Scale combined with years of education. Fasting venous blood samples were collected to detect inflammatory markers, especially high-sensitivity C-reactive protein (hs-CRP) and the platelet-to-lymphocyte ratio (PLR). RRR analysis was used to obtain inflammation-related dietary patterns using hs-CRP and PLR as response variables. Multivariate logistic regression model was used to analyze the association between dietary pattern score and the risk for cognitive impairment. Restricted cubic spline was used to explore the dose response relationship, and mediation analysis was used to quantify the mediating effects of hs-CRP and PLR.Results:Two dietary patterns were identified with RRR. The primary pattern was characterized by higher intakes of flour, red meat, and dairy products, and lower intake of fresh vegetables, explaining 6.84% of the variance in food intake and 0.50% of the variance in inflammatory markers. Compared with the T1 group, the T3 group had significantly higher risk for cognitive impairment ( OR=1.242, 95% CI: 1.034-1.491). Each one standard deviation increase in the dietary pattern score was associated with an 8.7% increase in the risk for cognitive impairment ( OR=1.087, 95% CI: 1.008-1.172), with a significant linear trend (overall-model P<0.001, non-linear P=0.295). Mediation analysis indicated that hs-CRP mediated 6.2% of the association between the dietary pattern and the risk for cognitive impairment. Conclusion:The inflammation- related dietary pattern characterized by higher consumption of flour, red meat, and dairy products and lower consumption of fresh vegetables is associated with an increased risk for cognitive impairment in older adults, and hs-CRP partially mediates this association.

Three-dimensional(3D)printing technology,which is based on computer aided design,presents innovative solutions for clinical surgical treatments and is increasingly being utilized in clinical settings.By integrating medical-image processing software and a 3D printer with customized materials,physicians can efficiently fabricate a 3D model layer by layer,thus realizing the reconstruction of human-body models with specific objectives.These models vividly showcase the anatomical structures,fracture types,and rupture severity,thereby facilitating doctors in understanding the fracture being examined.Beyond serving as a mere demonstration tool,the physi-cal model assists doctors in designing personalized implants and selecting customized surgical guide plates and fixation screws.Surgeons can improve the surgical accuracy and efficacy by refining the surgical plan via preoperative simulation operations.This article presents a summary of the application of computer-simulation surgery in conjunction with 3D printing technology in various complex surgeries.Addi-tionally,the significant potential applications of 3D printing technology in the clinical orthopedics field are discussed.

ObjectiveTo investigate the protective effects and mechanisms of Zhenzhu Tiaozhi capsules on the kidneys in the mouse model of diabetic kidney disease. MethodsThirty male C57BL/6J mice were selected as experimental objects. The model of diabetic kidney disease was induced by intraperitoneal injection of streptozotocin （STZ） at 40 mg·kg^-1 for 5 days combined with a high-fat diet （HFD）. Fasting blood glucose （FBG） ≥ 11.1 mmol·L^-1， increased urine volume， and continuous appearance of proteinuria indicated successful modeling. Mice were grouped as follows： Blank， model， low- and high-dose （0.98 and 1.96 g·kg^-1， respectively） Zhenzhu Tiaozhi capsules， and losartan potassium （30 mg·kg^-1）， with six mice in each group. After 12 weeks of continuous gavage， urine and kidney specimens were collected， and the 24-h urinary protein and the urinary albumin-to-creatinine ratio （UACR） in mice were measured. Hematoxylin-eosin （HE） staining， periodic acid-Schiff （PAS） staining， and Masson staining were performed for observation of histopathological changes in kidneys. Immunofluorescence assay was employed to detect the positive expression of the podocyte marker protein nephrin. Oil red O staining was used to detect renal lipid deposition. Enzyme linked immunosorbent assay was employed to measure the levels of interleukin-1β （IL-1β）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） in the renal tissue. Western blot was employed to determine the expression levels of sterol regulatory element-binding protein cleavage-activating protein （SCAP）， sterol regulatory element-binding protein-1c （SREBP-1c）， and NOD-like receptor protein 3 （NLRP3） in the renal tissue. ResultsCompared with the blank group， the model group showed increases in 24-h urinary protein and UACR （P<0.05）， glomeruli exhibiting capsule adhesion， collagen fiber deposition， mesangial proliferation， and inflammatory cell infiltration， elevated levels of IL-1β， IL-6， and TNF-α （P<0.05）， reduced positive expression of nephrin （P<0.05）， increased lipid deposition （P<0.05）， and up-regulated expression of SCAP， SREBP-1c， and NLRP3 （P<0.05） in the renal tissue. Compared with the model group， the treatment with losartan potassium or high-dose Zhenzhu Tiaozhi capsules for 12 weeks decreased 24-h urinary protein and UACR （P<0.05）， and the treatment with low-dose Zhenzhu Tiaozhi capsules for 12 weeks reduced the 24-h urinary protein （P<0.05）. Pathological staining results revealed that kidney damage in mice from all treatment groups was alleviated， with reduced inflammatory infiltration， collagen fiber deposition， and mesangial proliferation， and increased positive expression of nephrin in the renal tissue （P<0.05）. In addition， all the treatment groups showed reduced lipid droplets （P<0.05）， lowered levels of IL-1β， IL-6， and TNF-α （P<0.05）， and down-regulated expression of SCAP， SREBP-1c， and NLRP3 （P<0.05） in the renal tissue. ConclusionZhenzhu Tiaozhi capsules can ameliorate kidney damage in the mouse model of diabetic kidney disease by inhibiting the activation of the SCAP-SREBP-1c/NLRP3 signaling pathway， which reduces renal lipid deposition and inflammation.