Objective: To investigate morphological differences between obstructive and non-obstructive coronary artery disease (CAD) patients using computer-aided image analysis, and identify color and texture features for traditional Chinese medicine (TCM) syndrome differentiation. Methods: This prospective study enrolled patients undergoing coronary computed tomography angiography (CTA) at the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine between May 1, 2024 and August 7, 2025. Based on CTA results, patients were categorized into obstructive CAD and non-obstructive CAD groups. Standardized tongue images were acquired using a dedicated mobile application (Traditional Chinese Medicine Tongue Image-Assisted Diagnosis System) and analyzed for the overall tongue surface and three macroscopic features (tooth marks, fissures, and red dots) from which high-dimensional color and texture parameters were extracted. Multi-scale texture features were derived using spatial-domain Laplacian pyramid and frequency-domain wavelet transform methods. Dimensionality reduction and feature selection were performed using principal component analysis (PCA) and random forest with 5-fold cross-validation. Feature stability was assessed using Hodges-Lehmann estimator and Cliff’s δ. A multi-view XGBoost model was developed to differentiate the two groups and evaluated on a temporally independent validation set using accuracy and the area under the receiver operating characteristic curve (AUC). SHapley Additive exPlanations (SHAP) analysis was applied to interpret model decisions. Results: This study analyzed 373 CAD patients, including 167 with obstructive CAD and 206 with non-obstructive CAD according to CTA results. The whole cohort was divided into training set (n = 316, obstructive : non-obstructive = 142 : 174 ) and validation set (n = 57, obstructive : non-obstructive = 25 : 32), with balanced baseline characteristics (P > 0.05). Macroscopic tongue analysis revealed that patients with obstructive CAD had fewer tooth marks [odds ratio (OR) = 0.43, P < 0.05] and red dots (OR = 0.46, P < 0.05). High-dimensional color analysis identified pronounced intergroup differences, most notably a reduction in hue values in the hue-saturation-intensity (HSI) color space among obstructive CAD patients (Cliff’s δ = – 0.31, P = 2.72 × 10–6; Hodges-Lehmann estimator: – 0.31). PCA results suggested that tongue surface features explained the highest proportion of variance (48.2%). Random forest screening identified 77 stable features across all tongue regions, with wavelet-transformed texture features demonstrating the highest importance. The multi-view XGBoost fusion model achieved an accuracy of 75% and an AUC of 0.779 in the independent validation set. SHAP analysis identified the wavelet-based feature—left-handed lower-level gray-level size zone matrix zone variance (LHL_glszm_ZoneVariance) as the top predictor, accounting for 40.6% of the model's decision variance, and indicated that 85.3% of the predictive power came from wavelet-based texture features. Conclusion This study has provided objective evidence for the TCM concept that “the tongue reflects the heart” by identifying distinct morphological and colorimetric tongue patterns in patients with obstructive CAD through artificial intelligence (AI)-driven image analysis, and the promising performance of the computational model suggests its potential as a non-invasive adjunctive tool for CAD assessment.

First recorded in an official medical book from the Northern Song Dynasty called Taiping Huimin Heji Ju Fang （Prescriptions of the Bureau of Taiping People's Welfare Pharmacy）， Xiaoyaosan has been developed and refined over generations and is preserved to this day. It specializes in soothing the liver，resolving stagnation，fortifying the spleen，and nourishing blood. In this study，ancient traditional Chinese medicine （TCM） books and contemporary studies were reviewed to obtain information on Xiaoyaosan using bibliometrics，including its historical development，dosage，origin，processing methods，decoction dosage，and ancient and modern indications. Furthermore，a question regarding the presence of Zingiberis Rhizoma Recens and Menthae Haplocalycis Herba in Xiaoyaosan was investigated，and a table of key information on Xiaoyaosan was compiled，providing references for developing Xiaoyaosan preparations. According to the weight and measurement system of the Song dynasty，the contemporary equivalent formulation of the decocted Xiaoyaosan consists of 20.65 g of Glycyrrhizae Radix et Rhizoma and 41.3 g of Angelica Sinensis Radix，Poria，Paeoniae Radix Alba，Atractylodis Macrocephalae Rhizoma，and Bupleuri Radix. The formulation is processed to obtain a mixed powder with a particle size of 10 mesh. For each dose，8.25 g of the mixed powder is combined with 1 g of unprocessed Zingiberis Rhizoma Recens and 0.62 g of Menthae Haplocalycis Herba in 300 mL of water. The mixture is decocted until the volume reaches 210 mL，and the residue is then removed，with no specific timing required for administration. After the processing，each dose consists of approximately 0.75 g of Glycyrrhizae Radix et Rhizoma and 1.50 g of Radix Angelica Sinensis，Poria，Paeoniae Radix Alba，Atractylodis Macrocephalae Rhizoma，and Bupleuri Radix. Ancient medical literature shows that Xiaoyaosan primarily treats blood deficiency and overstrain，specifically for symptoms including heat caused by blood deficiency and fatigue，irregular menstruation，headache，eye soreness，pain in the ribs and limbs，and emaciation and bone steaming. In the Qing Dynasty，ZHANG Lu clearly proposed the pathogenesis of liver depression，and since then，the use of Xiaoyaosan in treating various syndromes associated with liver depression has been highly praised by physicians in the Qing dynasty and modern times. Xiaoyaosan has a wide application in modern clinical practices，involving digestive diseases，gynecological diseases，psychological diseases，nervous system diseases，and otorhinolaryngologic diseases. Moreover，it is most commonly used to treat depression and other diseases complicated with depression，hyperplasia of the mammary gland，etc. The key information on Xiaoyaosan and its clinical applications in ancient and modern times investigated in the study could serve as a scientific reference for in-depth research and extended clinical applications of the prescription.

Objective To explore the application effect of 3D printed individualized model in the treatment of complex ankle fractures(AF).Methods Patients with complex AF admitted to our hospital from July 2021 to October 2022 were selected and divided into the control group and the observation group using a random number table method,with 50 cases in each group.Patients in the control group were received minimally invasive reduction and internal fixation,while these in the observation group were given minimally invasive reduction and internal fixation under the guidance of 3D printed individualized model.The surgical conditions,ankle joint reduction,stress indicators[norepinephrine(NE)and angiotensin Ⅱ(AngⅡ)],ankle function and postoperative complications were compared between the two groups.Results There were 2 patients in the observation group and 3 patients in the control group were lost to follow-up 12 months after surgery.Compared with the control group,the observation group showed a decrease in the intraoperative blood loss,shortened surgical time,hospitalization time,and weight-bearing activity time,and an increase in the anatomical reduction rate(P<0.05).The observation group had lower serum levels of NE and AngⅡ 1 and 3 days after surgery(P<0.05)and higher Kofoed score and American Orthopedic Foot and Ankle Society(AOFAS)scores 1,6,and 12 months after surgery(P<0.05),as well as lower incidence of postoperative complications(P<0.05)than those in the control group.Conclusion For the treatment of complex AF,3D printed individualized model assisted the formulation of minimally invasive reduction and fixation surgical plans before surgery can shorten surgical time,reduce stress injury,decrease the risk of complications,and simultaneously increase the anatomical reduction rate and improve ankle joint function,thereby accelerating postoperative recovery of patients.

Objective To validate the diagnostic performance and risk stratification ability of an AI-based recognition system(PE-AI)for pulmonary embolism(PE)using computed tomography pulmonary angiography(CTPA)so as to analyze its diagnostic value in clinical practice.Methods A total of 416 patients with suspected PE who underwent CTPA from January 1,2023 to December 10,2023 at our hospital were included in this study.Two junior radiologists and PE-AI separately detected and diagnosed emboli in the collected cases by double-blind method,and recorded the diagnosis time respectively.Three senior radiologists reviewing with clinical follow-up results were used as the gold standard in this study.Diagnostic performance was evaluated by using the receiver operating characteristic(ROC)curve analysis and Delong-t test.For positive cases,the pulmonary artery obstruction index(PAOI)calculated by AI and manually were collected respectively and consistency analysis was performed.Results The area under the curve(AUC)of PE-AI,manual and combined diagnosis was 85.6％,90.8％and 95.1％,respectively,which differed significantly(P＜0.05).The reading time of PE-AI[(0.16±0.07)min]was significantly lower than the time of manual[(4.42±1.85)min,P＜0.001]and combined diagnosis[(4.58±1.84)min,P＜0.001].The PAOI measured by PE-AI and manually had high consistency(intraclass correlation efficient,ICC=0.80)in the subgroup analysis of confirmed cases.Conclusion AI can quickly identify pulmonary artery emboli in a short time and assist radiologists to improve diagnostic efficiency.At the same time,through the intelligent detection of PAOI,it is helpful for the risk stratification of patients with PE and optimizing the diagnosis and treatment pathway for pulmonary embolism.

This article reviews the benifits and challenges of nano-microspheres (NPs) in the treatment of osteoarthritis (OA). OA is a degenerative disease associated with aging, trauma, and excessive loading, with treatment strategies including basic therapy, drug therapy, reparative therapy, and reconstructive surgery. As emerging nanomaterials, NPs offer unique advantages in promoting cartilage repair due to their high surface area, excellent drug-loading capacity, and good biocompatibility. These advantages include facilitating chondrocyte generation through magnetic-mechanical control of mesenchymal stem cell microspheres and enhancing antioxidant levels using biomimetic liposomal NPs combined with glucosamine. Additionally, NPs can effectively modulate inflammatory responses, such as by inhibiting the formation of M1 macrophages and promoting their polarization to the M2 type to alleviate inflammation. Some NPs also enhance joint lubrication and relieve pain, such as hyaluronic acid-based NPs modified with choline phosphate groups. However, the application of NPs faces challenges such as high production costs, poor biocompatibility for certain types, and unknown long-term safety. Despite these challenges, with advancements in nanotechnology and a deeper understanding of the pathological mechanisms of OA, NPs are expected to provide new therapeutic approaches and more comprehensive and effective treatment options for OA patients in the future.

Objective:To evaluate the clinical efficacy of a novel reduction device in the treatment of A3N0/1 thoracolumbar fracture using navigation-assisted techniques.Methods:A retrospective analysis was conducted on 45 patients (29 males, 16 females; mean age 40.67±16.11 years, range 24-57) with thoracolumbar fractures who underwent fracture reduction and pedicle screw fixation via the Wiltse approach at Zhengzhou Orthopaedic Hospital between January 2022 and January 2023. Injury levels included: T 10 in 2 cases, T 11 in 5 cases, T 12 in 13 cases, L 1 in 20 cases, L 2 in 3 cases, L 3 in 2 cases. All patients underwent fracture reduction via the Wiltse approach using the spinal fracture reduction instrument for vertebral body reduction. Among them, 20 patients received O-arm navigation-assisted internal fixation and vertebral reduction (O-arm group), while 25 received C-arm fluoroscopy-guided internal fixation and vertebral reduction (C-arm group). Operative time, intraoperative blood loss, vertebral reduction time using the instrument, first-time screw placement success rate, screw placement accuracy, and complications were compared. Mid-vertebral body height ratio (MVBHr), local Cobb angle of the fractured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) were compared preoperatively, at 1 week postoperatively, 3 months postoperatively, and final follow-up. Results:All surgeries were successfully completed in both groups. Operative time was significantly shorter in the O-arm group (106.8±14.4 min) than in the C-arm group (119.1±16.4 min, P<0.05). All patients were followed up for a mean duration of 15.9±3.9 months (range 12-20 months). Vertebral reduction time was significantly shorter in the O-arm group (11.0±2.2 min) than in the C-arm group (20.4±5.7 min, P<0.05). The first-time screw placement success rate was significantly higher in the O-arm group (100%) than in the C-arm group (95.3%, P<0.05). Screw placement accuracy (Grade I) was significantly higher in the O-arm group (117 screws, 97.5%) than in the C-arm group (136 screws, 90.7%, P<0.05). No cases of wrong-level surgery, infection, or spinal cord/nerve injury occurred. Both groups showed significant improvements in MVBHr, Cobb angle, VAS, and ODI at all postoperative time points compared to preoperative values ( P<0.05). At final follow-up, the O-arm group demonstrated significantly better outcomes than the C-arm group in MVBHr (90.6%±4.5% vs. 86.4%±6.9%, P<0.05), Cobb angle (7.6°±1.8° vs. 10.1°±3.2°, P<0.05), VAS (1.3±0.4 vs. 1.7±0.6, P<0.05), and ODI (4.6%±1.9% vs. 7.7%±2.0%, P<0.01). Conclusion:O-arm navigation-assisted intrasegmental push reduction for A3N0/1 type thoracolumbar fractures demonstrates advantages including faster and more accurate screw placement, precise reduction with improved outcomes, and significant postoperative pain relief.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

We report the clinical course from birth to adolescence of a patient carrying a compound heterozygous variation in the ectonucleotide pyrophosphatase/phosphodiesterase family member 1(ENPP1) gene. The patient was diagnosed with generalized arterial calcification of infancy shortly after birth, and subsequently with autosomal recessive hypophosphatemic rickets type 2 at the age of 11 years. Following effective blood pressure control, treatment with neutral phosphate, calcitriol, and vitamin D was initiated. During follow-up, no progression of vascular calcification was observed. Through this case report and a review of relevant literature, we aim to enhance clinicians′ understanding of this rare condition.

Objective:To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities.Methods:This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants′ dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors.Results:The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions:Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.

Objective:To learn about both the distribution of resources of radiodiagnostic and radiotherapeutic and the frequencies of radiological examinations to provide a basis for rational allocation of medical resources and standardize medical ionizing radiation.Methods:Based on the data on permanent resident population and the data reported by the Suzhou medical institutions in possesion of radiological equipment to the " Suzhou radiological health information management platform", a summary was made of the number of items of radiological equipment and the frequencies of radiological examinations in Suzhou medical institutions in 2022 and 2023.Results:In 2023, there were 368 medical institutions with radiological equipment in Suzhou, including 28 tertiary hospitals, 58 secondary hospitals, 159 primary hospitals and 123 unrated others. The total number of the items of radiological equipment was 1 688, with 39 items more than in 2022, about 1.30 units per 10 000 population. There were 5 187 medical radiation workers in total, with 339 more than in 2022. The frequencies of radiological procedures were 1 157.961/per thousand population, with 37.70% being from computed tomography in 2023.Conclusions:The number of items of radiodiagnostic and radiotherapeutic equipment and the frequencies of radiological procedures was at a relatively high level in China, but the distribution of medical resources were in a unbanlanced state. Efforts should be focused on optimization of the allocation of medical resources for the sake of reducing the public radiation dose and protecting public health.