Background: This study quantifies the global burden of alopecia areata (AA) in young adults (15–49 years) from 1990 to 2021 using data from the Global Burden of Disease 2021 study. Objective: To analyze trends in AA incidence and disability-adjusted life years (DALYs) across demographic and geographic strata. Methods: We evaluated age-standardized incidence rates (ASIRs) and age-standardized DALYs rates, stratified by sex, age, and Socio-demographic Index (SDI). Estimated annual percentage changes (EAPCs) were calculated to assess trends. Results: Global ASIR (EAPC, −0.20) and DALY rates (EAPC, −0.19) for AA declined 1990–2021, with larger declines in women, peak rates in 30–34-year-olds, and most prominent declines in high-SDI regions. High-SDI regions accounted for 42% of global DALYs (18% of the population). East Asia (ASIR EAPC, 0.02) and Oman (ASIR EAPC, 0.46) had rising incidence; East Asia (DALY EAPC, 0.04) and Guatemala (DALY EAPC, 0.48) had rising burden. SDI correlated positively with AA burden (ASIR: r=0.68, p<0.01; DALYs: r=0.72, p<0.001). Conclusion Significant disparities exist in AA burden, with higher rates in females and a peak in young adulthood. The strong positive correlation with SDI highlights the disproportionate impact of AA on high-income nations.

The incidence of age-related macular degeneration(AMD)is rising with the intensifying aging trend,be-coming a critical challenge that demands urgent solutions.Dry AMD(dAMD)accounts for approximately 80％of all AMD cases,and there is currently a lack of highly effective treatment options.In recent years,traditional Chinese medicine(TCM)has been proven to effectively treat dAMD through actions such as antioxidation,anti-apoptosis,anti-inflammation,and lipid-lowering.By reviewing domestic and international literature,this article discusses TCM monomers,extracts,and compound formulations for dAMD,analyzing their various mechanisms.Based on traditional TCM efficacy theories and in-tegrated with modern mechanisms of action,it targets the active components of TCM to elucidate the connection between effective medicinal targets of TCM and dAMD,thereby clarifying the efficacy and scientific basis of TCM monomers,com-pounds,and extracts in treating dAMD.The aim is to provide new perspectives for the prevention and clinical treatment of dAMD.

AIM:To investigate the mechanism of reduced tear secretion in depression-related dry eye rats based on 5-HT/TRPV4/AQP5.METHODS:Healthy SD male rats were established with chronic unpredictable mild stress(CUMS)method to establish a depression-induced dry eye model(n=8), and the control group was blank rats(n=8). The ELISA method was used to compare the 5-hydroxytryptamine(5-HT)in serum and hippocampal tissue of the two groups, and the HE sections of lacrimal gland and AQP5 immunohistochemistry were observed. Western blot and RT-PCR were used to detect the expression of 5-HT3R, TRPV4 and AQP5 in the lacrimal gland tissue of the two groups of rats.RESULTS:The tear secretion in the depression-induced group was significantly reduced(P=0.001), the serum and hippocampal 5-HT levels were significantly reduced(all P<0.05), the expression of AQP5 antibody in the lacrimal gland immunohistochemistry was significantly lower than that in the control group(P<0.001), the expression of 5-HT3R, TRPV4 and AQP5 in the lacrimal gland was significantly reduced(all P<0.05), and no obvious inflammatory cells were found in the lacrimal gland tissue sections.CONCLUSION:Depression-related dry eye may occur through a non-inflammatory 5-HT/TRPV4/AQP5 mechanism.

AIM:To investigate the mechanism of reduced tear secretion in depression-related dry eye rats based on 5-HT/TRPV4/AQP5.METHODS:Healthy SD male rats were established with chronic unpredictable mild stress(CUMS)method to establish a depression-induced dry eye model(n=8), and the control group was blank rats(n=8). The ELISA method was used to compare the 5-hydroxytryptamine(5-HT)in serum and hippocampal tissue of the two groups, and the HE sections of lacrimal gland and AQP5 immunohistochemistry were observed. Western blot and RT-PCR were used to detect the expression of 5-HT3R, TRPV4 and AQP5 in the lacrimal gland tissue of the two groups of rats.RESULTS:The tear secretion in the depression-induced group was significantly reduced(P=0.001), the serum and hippocampal 5-HT levels were significantly reduced(all P<0.05), the expression of AQP5 antibody in the lacrimal gland immunohistochemistry was significantly lower than that in the control group(P<0.001), the expression of 5-HT3R, TRPV4 and AQP5 in the lacrimal gland was significantly reduced(all P<0.05), and no obvious inflammatory cells were found in the lacrimal gland tissue sections.CONCLUSION:Depression-related dry eye may occur through a non-inflammatory 5-HT/TRPV4/AQP5 mechanism.

OBJECTIVE: To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. METHODS: Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group ( n=32) and ORIF group ( n=36). There was no significant difference ( P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups. RESULTS: Compared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization ( P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups ( P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [ OR (95% CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group ( P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation ( P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups ( P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group ( P<0.05), but there was no significant difference in internal rotation between the two groups ( P>0.05). CONCLUSION Application of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.
Humans ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Shoulder Fractures/surgery* ; Arthroplasty, Replacement, Shoulder/methods* ; Aged ; Bone Plates ; Open Fracture Reduction/methods* ; Range of Motion, Articular ; Treatment Outcome ; Shoulder Joint/physiopathology* ; Aged, 80 and over ; Operative Time ; Postoperative Complications/epidemiology* ; Length of Stay

The incidence of age-related macular degeneration(AMD)is rising with the intensifying aging trend,be-coming a critical challenge that demands urgent solutions.Dry AMD(dAMD)accounts for approximately 80％of all AMD cases,and there is currently a lack of highly effective treatment options.In recent years,traditional Chinese medicine(TCM)has been proven to effectively treat dAMD through actions such as antioxidation,anti-apoptosis,anti-inflammation,and lipid-lowering.By reviewing domestic and international literature,this article discusses TCM monomers,extracts,and compound formulations for dAMD,analyzing their various mechanisms.Based on traditional TCM efficacy theories and in-tegrated with modern mechanisms of action,it targets the active components of TCM to elucidate the connection between effective medicinal targets of TCM and dAMD,thereby clarifying the efficacy and scientific basis of TCM monomers,com-pounds,and extracts in treating dAMD.The aim is to provide new perspectives for the prevention and clinical treatment of dAMD.

At present, countries around the world are paying greater attention to the protection of medicinal plants and traditional medicinal knowledge resources, and are looking for various ways to protect medicinal plants. Many countries have established their own databases to save the medicinal plant information resources. This paper focuses on the introduction of medicinal plant databases in six countries including Malaysia, Philippines, and Singapore, and compares their basic information. It is difficult to achieve integration and sharing among these databases. It brings certain difficulties to the use of researchers in related fields. It is suggested that the construction of a multinational common medicinal plant database should be included in the "Belt and Road Initiative" to systematically organize massive information, enhance exchanges between countries on traditional medicinal plants, and achieve medicinal plant information sharing, and the establishment of a shared database will reduce optimization and maintenance to a certain extent or renewal work, laying the foundation for the protection, development and sustainable use of traditional medicinal plant resources.

Objective:To evaluate the effectiveness of contrast-enhanced ultrasound in the differential diagnosis of atypical adenomyosis and fibroids using a decision tree model.Methods:The data of cases with difficulty in differentiating atypical adenomyosis from fibroids on conventional ultrasound examination at Shengjing Hospital of China Medical University from April 2021 to April 2022 were selected and analyzed. Ninety-five patients with contrast-enhanced ultrasound examination were finally selected, including 64 patients in the pathologically confirmed adenomyosis group and 31 patients in the fibroids group. The data from the qualitative analysis and the quantitative analysis of the time-intensity curve (TIC) curve were collected separately, including the temporal variability of contrast entry into the lesion, i.e.the difference between the time when the contrast agent started to enter the lesion and the time when the contrast agent finally filled the lesion completely. Indicators were first screened for inclusion in the decision tree model by univariate and multifactorial analyses, and decision tree models based on qualitative analysis indicators, and qualitative and TIC-based analyses were developed to further assess the diagnostic efficacy of both models.Results:Through the univariate analysis, it showed that the qualitative analysis indicators of lesion onset enhancement pattern, enhancement intensity, intra-lesion contrast distribution, and post-contrast lesion border were of statistical significance (all P<0.05) between the two groups. The differences in contrast arrive time (AT), contrast time to peak (TTP), |ΔAT|, and |ΔTTP| in the TIC curve analysis indexes were statistically significant between the two groups (all P<0.05). The difference in lesion temporal phase variability was statistically significant between the two groups ( P<0.05). After further screening by multifactorial analysis, the accuracy and misdiagnosis rates were 87.40% and (17.90±3.90)% in the qualitative analysis-based decision tree model respectively, and 90.50% and (21.10±4.20) % in the qualitative and TIC curve-based analysis decision tree model respectively. The ROC curves were plotted according to the two groups of models, and the areas under the curves were 0.915 and 0.931 respectively. Conclusions:A decision tree model based on ultrasonographic image analysis has diagnostic value for the differential diagnosis of atypical adenomyosis and uterine fibroids.

Lancang-Mekong countries refer to the six countries that the Lancang-Mekong River flows through， including China， Laos， Myanmar， Thailand， Cambodia， and Vietnam. These countries are geographically adjacent with similar cultures and have long history of traditional medicine and high plant diversity. Since ancient times， medicinal plants have been introduced into China from the countries along the river， including a variety of medicinal plants with edible and healthcare values， which is an important way for the transnational circulation of medicinal resources. This paper briefly described the history and application of edible medicinal plants in the six Lancang-Mekong countries and summarized more than 150 edible medicinal plants from the other five countries except China. These 150 medicinal plants belong to 66 families such as Labiatae， and 12 species of them are used as edible medicinal plants in all the six countries. Further， we collected the information of these edible medicinal plants， including the origins， efficacy， indications， medicinal edible parts， edible values， and the traditional application of these plants in China. Some valuable edible medicinal plants in the other five countries are considered to have a promising prospect of application in China and may be introduced to China as new medicinal resources. These efforts will be conducive to the cooperation in traditional medicine among Lancang-Mekong countries.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.