ObjectivesTo understand the prevalence of hyperhomocysteinemia （HHcy） in the Tibetan population in Northwest Xizang， and its association with lipids and blood uric acid， and to explore the prevention and treatment strategies for chronic diseases such as HHcy in Northwest Xizang. MethodsIn this survey， questionnaires， physical examinations， and biochemical tests were conducted on 3432 Tibetan residents aged 18 years and older who had resided in Northwest Xizang （Ngari Prefecture， Nagqu City） for more than 6 months using a multistage stratified whole cluster random sampling method. ResultsThe prevalence of HHcy among Tibetan residents in Northwest Xizang was 75.7%， much higher than that of the average population in China （37.2%）. Blood uric acid、high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were risk factors for HHcy. ConclusionThe prevalence of HHcy is higher in the Tibetan population in northwest Xizang. Therefore， the local governments should urge people to establish a healthy lifestyle and enhance early intervention for HHcy by improving diet and lifestyle， thereby reducing the risk of cardiovascular， cerebrovascular and other related diseases.

BACKGROUND:The basic principle of the design of the robot system used for total knee arthroplasty is to combine three-dimensional surgical planning,early warning of danger areas during surgery,real-time data feedback,robot arm assisted osteotomy and other technologies to achieve precision and personalization of total knee arthroplasty,which is exactly its biggest advantage.Therefore,it has become a hot topic in the field of joint surgery in recent years and attracted much attention. OBJECTIVE:To summarize the development status of robotic-assisted total knee arthroplasty in the field of joint surgery and the comparison of advantages and disadvantages with conventional total knee arthroplasty and to prospect the future development of robotic-assisted total knee arthroplasty. METHODS:Relevant articles were searched from PubMed,CNKI,Wanfang and VIP databases by computer.English key words were"robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR".Chinese key words were"robotic-assisted,computer navigation,total knee arthroplasty".Finally,64 articles were included for review and analysis. RESULTS AND CONCLUSION:(1)The robot system used to assist total knee arthroplasty is divided into active,semi-active and passive according to its degree of freedom.The semi-active system,currently widely used in robotic systems,effectively enhances the accuracy and personalization of total knee arthroplasty.However,its high implementation cost and relatively steep learning curve remain key factors to be balanced when promoting its adoption in joint surgery field.(2)Robotic-assisted total knee arthroplasty can achieve precise osteotomy and correct placement of prosthesis in local three-dimensional space of the knee joint.It has been widely proven that it can provide better accuracy of prosthesis implantation,reduce imaging abnormalities,obtain good soft tissue balance during the operation,and ultimately improve the motion and functional status of the knee joint after the operation.(3)However,the current robotic-assisted system still has objective shortcomings,including the problem of learning curve between different robot devices and operators,additional installation and maintenance costs,and potential complications related to robot surgery.Therefore,whether it can truly benefit the medical system and patients still needs to be proven by long-term research,and the robotic-assisted system also needs to be further improved substantially.(4)Robotic-assisted total knee arthroplasty technique is still in the preliminary research stage in clinical practice and has not been widely applied.To better define the usage of robotic-assisted total knee arthroplasty and enhance its clinical procedural standards and safety,refining these aspects will become a focal point of future research on robotic-assisted total knee arthroplasty.

Objective To study the mechanism of the treatment of metabolism associated steatohepatitis(MASH)in rats with Xiaoyao Wan.Methods Twenty-four SD male rats were randomly divided into control group(CON group,n=8)and model group(n=8).The model group was given high-fat diet,carbon tetrachloride(CCl4)subcutaneous injection,hunger and satiety disorder and tail clamping for four weeks to establish the MASH model,and the rats were randomly divided into the MOD group and the Xiaoyao Wan group(XYW group),with 8 rats in each group.The rats of the XYW group were given Xiaoyao Wan,the other two groups were given normal saline.Four weeks after administration,the serum biochemical indexes and oxidative stress indexes of rats in different groups were detected.The pathological sections of rat liver tissue were observed by hematoxylin-eosin(HE)stai-ning and oil red O staining.The expression of cytochrome P450 2E1(CYP2E1),factor-related apoptosis ligand(FasL),tumor necrosis factor-α(TNF-α)and tumor growth factor-β1(TGF-β1)in rat liver were detected by Western blot method.The relative contents of CYP2E1,FasL,TNF-α and TGF-β1 mRNA in liver tissue were de-tected by RT-qPCR.Results The general condition of rats in the XYW group was significantly improved compared with the MOD group;the level of hepatic index was significant decrease compared with the MOD group(P＜0.01)and the level of body mass index was significant increase compared with the MOD group(P＜0.01);the serum levels of triglyceride,total cholesterol,low-density lipoprotein cholesterol,aspartate aminotransferase,alanine aminotransferase,malondialdehyde,monocyte chemotactic protein-1,TNF-α,and interleukin(IL)-18 were signif-icantly reduced compared with the MOD group(all P＜0.05),and the levels of high-density lipoprotein choles-terol,superoxide dismutase,and IL-10 were significantly elevated compared with the MOD group(all P＜0.05);the content of lipid droplets in hepatocytes of rats was significantly reduced compared with the MOD group under light microscope;the protein levels of CYP2E1,FasL,TNF-α and TGF-β1 in liver tissues were significantly re-duced compared with the MOD group(all P＜0.05),and the relative contents of CYP2E1,FasL,TNF-α and TGF-β1 mRNA were significantly reduced compared with the MOD group(all P＜0.05).Conclusion Xiaoyao Wan can regulate the expression of CYP2E1,FasL,TNF-α and TGF-β1 in the liver tissue of MASH rats by reduc-ing the accumulation of fat in the liver,so as to achieve the purpose of treating MASH.

Objective To explore and validate the application value of a deep learning model based on the Huawei Cloud ModelArts platform in the diagnosis of atypical cervical cells in liquid-based cytology(LBC)and to evaluate its assistive effect for pathologists with different diagnostic experiences.Methods We retrospectively analyzed 1 044 cervical cytology specimens from Dongguan People's Hospital in 2020.The artifical intelligence(AI)-assisted diagnostic system developed on the Huawei Cloud ModelArts platform was compared with junior,intermediate,and senior pathologists for diagnosis.Sensitivity,specificity,precision,recall,and area under the receiver operating characteristic curve(AUC)were calculated to assess the diagnostic performance of the Al system and its assistive effect for pathologists with different levels of experience.The McNemar test was used to compare the differences between the Al system and manual diagnosis.P＜0.05 was considered statistically significant.Results For the 1 044 cervical exfoliated cytology specimens,the sensitivity and specificity of the AI system in detecting atypical cells was 98.96％and 89.15％,both of which were higher than those of junior doctors(81.95％and 91.81％,respectively).The overall diagnostic accuracy of the Al system was 93.68％,which was significantly higher than that of junior doctors(87.26％,P＜0.001).Al assistance could significantly improve junior doctors'ability to detect atypical cells,with the sensitivity and specificity increasing from 80.1％to 96.5％and from 85.6％to 92.3％,respectively.Conclusion The AI-assisted cervical cytology diagnostic system developed in this study demonstrated superior performance,particularly in significantly improving the diagnostic level of junior pathologists,showing promising clinical application prospects.

[Objective]To observe and analyze the vitreoretinal interface changes in type 2 diabetic retinopathy(DR)by using ultra-wide field swept-source optical coherence tomography(UWF SS-OCT)/swept-source optical coherence tomography angiography(SS-OCTA).[Methods]This study enrolled 143 patient with diabetic mellitus.We performed SS-OCT on 258 eyes and OCTA on 69 eyes with proliferative diabetic retinopathy(PDR),then analyzed the images to assess the relationship between posterior vitreous detachment(PVD)and DR severity,and to measure the growth of retinal neovascularization in PDR eyes with different stages of PVD.[Results]PVD stage was negatively correlated with DR severity(Gamma=-0.294,P<0.001),that is,the more extensive the vitreoretinal adhesion,the more severe the DR.The negative correlation between PVD stage and DR severity was more evident in patients with diabetes duration more than 10 years(Gamma=-0.620,P<0.001).Retinal neovascularization occurred more commonly in the area of vitreoretinal adhesion.[Conclusions]The degree of vitreoretinal adhesion is closely related to the DR severity.It is very important to use SS-OCT to evaluate the vitreoretinal interface in the management of DR patients.

Objective: To understand the association of maternal emotional symptoms and parent-child relationship with emotional and behavioral problems (EBPs) in primary school students, so as to provide a reference for the prevention of EBPs in primary school students. Methods: In May 2023, a convenient cluster sampling method was used to select 1 324 students from two primary schools in Hefei City, Anhui Province as the study subjects. The Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9), Family Adaptation and Cohesion Evaluation ScalesⅡ (FACES Ⅱ), and Strengths and Difficulties Questionnaire (SDQ) of parental version were used to investigate maternal emotional symptoms, parent-child relationship, and EBPs of primary school students, respectively. Multivariate Logistic regression analysis model was used to analyze the association of different maternal emotional symptoms and parent-child relationship with EBPs of primary school students. Results: The abnormal detection rates of emotional symptoms, conduct problems, hyperactivity disorder, peer problems, prosocial behavior and total difficulties in primary school students were 13.6%, 19.4%, 20.2%, 36.5%, 20.9% and 51.9%, respectively. Multivariate Logistic regression analysis showed that the detection rates of EBPs in primary school students whose mothers had anxiety and depression symptoms with low level of parent-child relationship increased ( OR=1.52-6.97, P <0.01). The combined effect of mothers who had anxiety and depression symptoms with low level of parent-child relationship increased the risk of EBPs in all dimensions of primary school students ( OR=4.07-10.14, P <0.01). After gender stratification, the combined effect of mothers who had anxiety and depression symptoms with low level of parent-child relationship increased the risk of EBPs in all dimensions of boys and girls ( OR=3.71- 10.95 , P <0.01). Conclusions Maternal emotional symptoms and parent-child relationship are associated with EBPs in primary school students. Reducing maternal anxiety and depression symptoms, and improving parent-child relationship are beneficial to reduce the incidence of EBPs problems in primary school students.

Objectives:To retrieve,evaluate and summarize the contemporary evidence of strategies for weaning from extracorporeal membrane oxygenation(ECMO)of adult patients,and to provide evidence-based reference for clinical practice. Methods:The Web of Science,Embase,Cochrane Library,PubMed,Wanfang Database,CNKI,VIP website,SinoMed,BMJ Best Practice,National Institute for Health and Care Excellence,Joanna Briggs Institute Library,UpToDate and the website of Agency for Healthcare Research and Quality,Society of Critical Care Medicine,American Association of Critical-Care Nurses,European Society of Intensive Care Medicine and Extracorporeal Life Support Organization were researched to collect the literature related to randomized controlled trials,systematic reviews,guidelines,evidence summaries,expert consensuses and clinical decisions in this field.The time limit for the retrieval is from the inception of databases until July 2023. Results:A total of 13 related literature were retrieved,including 4 guidelines,4 expert consensuses,3 clinical decisions and 2 system reviews.Totally 42 evidences were formulated based on retrieved literature,including adequately accessing the ability of gas exchange before weaning from veno-venous ECMO(V-V ECMO)and withdrawing from veno-arterial ECMO(V-A ECMO)as soon as possible when patients's heart function has recovered,involving six aspects such as team composition,anticoagulation measures,assessment before weaning,weaning implementation,cannula and wound management and quality measures. Conclusions:It is suggested to build a professional ECMO team based on the actual hospital situation,to follow the contemporary evidence to standardize the weaning process of patients from ECMO to ensure the patients'safety and improve the outcomes.

Objective:To analyze the dosimetric differences between gamma knife stereotactic body radiation therapy (SBRT) and linear accelerator-based SBRT for lung tumors by comparison to provide a theoretical basis for the selection of treatment strategies.Methods:Seven patients who underwent SBRT for lung tumors in the Cancer Center of Affiliated Zhongshan Hospital of Dalian University from January 2022 to May 2023 were enrolled. Plans of gamma knife SBRT (γ_SBRT) or linear accelerator-based SBRT plans (X_SBRT) were designed for the 13 lesions in the patients, with adjacent lesions in the same patient sharing one plan. As a result, 10 γ_SBRT plans and 10 X_SBRT plans were obtained. All lesions received 30-50 Gy of radiation in 5-10 fractions. Then, dosimetric parameters were analyzed and compared between γ_SBRT and X_SBRT plans, including the target coverage, gradient index (GI), conformity index (CI), maximum dose ( Dmax); mean dose ( Dmean), and minimum dose ( Dmin) of planning target volumes (PTVs); lung volumes receiving 20 Gy or more ( V20), 10 Gy or more ( V10), 5 Gy or more ( V5), 100% of the prescription dose ( V100%), and 50% of the prescription dose ( V50%); Dmean and the percentages of lung volume receiving doses of 20 Gy or more (Lung_ V20) and 5 Gy or more (Lung_ V5) of ipsilateral lung; Dmean and Lung_ V5 of contralateral lung; and Dmax values of the esophagus, spinal cord, and heart. Results:Compared to X_SBRT plans, γ_SBRT plans exhibited superior GI, V20, V10, V5, V50%, the Dmean, Lung_ V20, and Lung_ V5 of ipsilateral lung, the Dmean and Lung_ V5 of the contralateral lung, and the Dmax of esophageal and heart ( z = -2.81 to -1.99, P < 0.05), higher Dmax and Dmean of PTVs ( z = -2.80, -2.80, P < 0.05), and longer delivery time ( z=-2.70, P<0.05). Meanwhile, there was no significant difference in target coverage, CI, and Dmax of the spinal cord ( P > 0.05). Conclusions:Gamma knife SBRT plans can achieve sharper dose falloff outside target volumes than linear accelerator-based SBRT plans. Gamma knife radiosurgery is expected to reduce the radiation dose to low-dose areas around PTVs and normal lung tissue in SBRT for lung tumors. However, it significantly prolongs the delivery time.

Objective To analyze the disease burden of multidrug-resistant tuberculosis (MDR-TB) in China and regions with different income levels in the world from 1990 to 2019. Methods Using the Global Burden of Disease Study 2019 (GBD2019) results, the changes of the disease burden of MDR-TB in China and regions with different income levels in the world were described and analyzed using the Joinpoint Regression Program 4.8.0.1 software. Results From 1990 to 2019, the age standardized incidence, mortality and DALY rates in China and other areas with different income levels in the world basically showed a trend of first rising and then decreasing at the turning point of the late 20th century and early 21st century, except for low-income areas where the age standardized incidence rate showed an overall upward trend. In 2019, the incidence rate, mortality and DALY rate of MDR-TB in China were 9 times, 6.67 times and 6.89 times higher than those in high-income areas, respectively. The incidence rate in China was 6 times lower than that in low and middle-income areas, while the mortality and DALY rate in China were 26 times and 32.53 times lower than those in low-income areas, respectively. The age standardized incidence, mortality rate and DALY rate of MDR-TB in men were higher than those in women. Risk factors for the burden of MDR-TB disease included alcohol consumption, smoking, and high fasting blood glucose. Conclusion From 1990 to 2019, there are significant regional and gender differences in the disease burden of multidrug-resistant tuberculosis in China and regions with different income levels in the world. Multidrug-resistant tuberculosis is still a major challenge for tuberculosis control in the world. It is necessary to develop more effective control strategies and health care systems to deal with multidrug-resistant tuberculosis.

Background Subways are typical congregate settings and may facilitate aerosol transmission of viruses. However, quantified transmission probability estimates are lacking. Purpose To model spread and diffusion of respiratory aerosols in subways by simulation and calculation of infection probabilities. Methods The internal environment of carriages of Shanghai Metro Line 10 was used to establish a study scene. The movement of tiny particles was simulated using the turbulent model. Trend analysis of infection probabilities and viral quantum doses was conducted in a closed subway carriage scene by a quantum emission-infection probability model. Results Under a typical twelve-vent air conditioning configuration, respiratory droplet aerosols within a subway carriage dispersed rapidly throughout various regions due to airflow, with limited short-term diffusion to other carriages. Concurrently, owing to the uncertainty of airflow patterns, the airflow might circulate and converge within carriages, causing delayed outward dispersion or hindered dispersion of droplet aerosols upon entry into these zones. Passengers boarding the carriage could exacerbate the formation of these zones. When the air conditioning system functioned adequately (air exchange rate=23.21 h⁻¹), the probability of a virus carrier transmitting the virus to other passengers within the same carriage via aerosol transmission was approximately 3.8%. However, in the event of air conditioning system failure (air exchange rate=0.5 h⁻¹), this probability escalated dramatically to 30%. Furthermore, a super-spreader (with virus spreading exceeding 90% of the average) elevated the infection probability to 14.9%. Additionally, due to the complexity of turbulence within the carriage, if local diffusion occurred in 1/2 zones of a carriage, the anticipated infection probability would increase to 8.9%, or during the morning or evening rush hours leading to elevated aerosol concentrations, the infection probability would rise to 4.7%. The subway transmission probability for common coronaviruses diminished to as low as 0.9%. Conclusion Combined computational fluid dynamics and infection probability analysis reveals that in the prevalent twelve-vent air conditioning configurations, despite being a major transportation hub with substantial spatial-temporal overlap, the internal space of subway carriages exhibits a certain level of resistance to virus aerosol transmission owing to built-in ventilation capabilities. However, turbulence and passenger positioning may lead to localized hovering of droplet aerosols, thereby increase the risk of virus transmission. Furthermore, super-spreaders, poor operational status of built-in air conditioning system, and high passenger volume at morning or evening peak hours exert profound effects on virus transmission and infection probability.