BACKGROUND:Confirming the reliability and validity of the My jump 2 application for measuring lower limb vertical stiffness may offer the possibility of it as an alternative to the Kistler three-dimensional force platform for measuring lower limb stiffness. OBJECTIVE:To verify the reliability and validity of the My Jump 2 application in measuring lower limb vertical stiffness of college students. METHODS:The drop jump data of the participants were collected through the Kistler three-dimensional force platform and the My Jump 2 application,and the vertical stiffness of the participants'lower limb vertical stiffness was calculated.The intraclass correlation coefficient was used to analyze the data measured by the My Jump 2 application and the Kistler three-dimensional force platform,attempting to verify the reliability of the My Jump 2 application.The bias and average between the two devices were drawn into a Bland-Altman diagram to verify the consistency between the two test methods.Finally,the test-retest reliability of the My Jump 2 applications at 30 cm and 40 cm was analyzed using the Cronbach's alpha(α)and coefficient of variation.Pearson product-moment correlation was used to analyze the correlation of My Jump 2 applications. RESULTS AND CONCLUSION:My Jump 2 application has high reliability and validity when measuring the vertical stiffness of the lower limb.At the same time,due to its advantages of low cost,convenient portability and field testing for large samples,it can be used as an alternative to the Kistler three-dimensional force platform to test the vertical stiffness of the lower limb in college students and similar populations.

Objective:To examine the clinical subtypes of patients with multisystem atrophy(MSA)that may indicate the prognosis of patients.Additionally, we aim to compare the ability to perform daily activities among patients of each subtype using cluster analysis.Methods:The retrospective analysis included demographic data, clinical symptoms and signs, scale scores, and ancillary examinations of 94 patients diagnosed with multisystem atrophy at Xuanwu Hospital of Capital Medical University.The study aimed to analyze the clinical characteristics of each subtype obtained through clustering.Additionally, a comparison was made between patients with traditional motor subtypes and those with new subtypes in terms of activities of daily living.The study consisted of 94 MSA patients, with an average age of 61 years and a female representation of 51.1%.Using the data collected on the continuum, a full linkage hierarchical cluster analysis was performed to classify MSA patients into four clinical subtypes: gait disorder(17 cases, 18.1%), malignant tonic hyperkinetic with premature haircut(25 cases, 26.6%), intermediate(43 cases, 45.7%), and autonomic benign type(9 cases, 9.6%).Each subtype exhibited various clinical motor and non-motor symptoms, including UPDRS-Ⅲ( χ2=27.90, P<0.001), gait disturbance( χ2=33.23, P<0.001), MoCA( χ2=10.98, P=0.012), HAMA( χ2=12.14, P=0.007), HAMD( χ2=13.62, P=0.003), smell score( χ2=10.16, P=0.017), postural hypotension( χ2=14.59, P=0.028), and a statistically significant difference in the ability to perform daily living score( χ2=25.35, P<0.001).No statistically significant differences in non-motor symptoms and activities of daily living abilities were observed between the cerebellar and Parkinsonian types of traditional motor typing( P>0.05). Conclusions:The hierarchical clustering analysis conducted in this study reveals that the clinical phenotype of MSA provides a more accurate reflection of patients' clinical characteristics and their impact on quality of life compared to the traditional motor phenotype.Additionally, it may help predict variations in the underlying pathological impairment and the rate of disease progression.These findings offer a foundation for precise diagnostic interventions in patients with MSA.

Bisphenols are widely used in the manufacture of polycarbonates and plastics. With the restriction and banning of bisphenol A (BPA), a typical representative of bisphenols, bisphenol S (BPS) has been widely used in the manufacture of various polymers as the main alternative to BPA. Humans are exposed to BPS through a variety of routes, and BPS is detected in food, environment, and human blood and excreta. Concerns about the safety of BPS have become an important issue, especially for pregnant women and fetuses. The results of several studies support that prenatal exposure to BPS have multiple adverse effects on the offspring. In particular, prenatal BPS exposure may affect maternal and offspring metabolic homeostasis and increase the risk of abnormal lipid metabolism in the offspring. This paper summarized the results of studies on BPS exposure and abnormal lipid metabolism. In addition, this review explored potential mechanisms of BPS, including its possible influence on lipid metabolism through interference with hormone receptors, activation of the nuclear receptor peroxisome proliferator-activated receptor γ (PPARγ), induction of oxidative stress and inflammatory states, and epigenetic effects. These findings emphasized the importance of more in-depth research on BPS and its potential effects to better understand its impact on human health and to provide a basis for developing appropriate public health measures to reduce the risk of BPS exposure.

Objective To investigate the expression and clinical significance of serum long non-coding RNA small nucleolar RNA host gene 16(lncRNA SNHG16)and mothers against decapentaplegic homolog 4(SMAD4)in elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection(PI).Methods A total of 237 elderly COPD patients admitted to the hospital from January 2021 to January 2023 were enrolled in the study.Among them,117 patients with concomitant PI were classified as the concur-rent group,and 120 patients without concomitant PI were classified as the COPD group.Real-time fluores-cence quantitative polymerase chain reaction(qRT-PCR)was applied to detect the expression level of serum lncRNA SNHG16 in two groups.Enzyme linked immunosorbent assay(ELISA)was applied to detect the lev-el of SMAD4 in patients'serum.Simplified clinical pulmonary infection scale(sCPIS)was used to evaluate the degree of PI of patients in the concurrent group.Multivariate Logistic regression was applied to analyze the in-fluencing factors of PI in elderly COPD patients.Correlation between serum lncRNA SNHG16,SMAD4 levels and sCPIS in elderly COPD patients with PI was analyzed by using Spearman correlation analysis.Receiver op-erating characteristic(ROC)curve was applied to analyze the diagnostic value of serum lncRNA SNHG16 and SMAD4 levels in elderly COPD patients with PI.Results The serum relative expression level of lncRNA SNHG16 in the concurrent group was higher than that in the COPD group,but the serum SMAD4 level was lower than that in the COPD group(P<0.05).In addition,the proportions of patients with age≥70 years,smoking history,complicated with diabetes and COPD course≥5 years and the levels of tumor necrosis fac-tor-α(TNF-α),interferon-γ(INF-γ)in the concurrent group were higher than those in the COPD group,and FEV1/FVC and the level of interleukin-10(IL-10)in concurrent group were lower than those in COPD group(P<0.05).Multivariate Logistic analysis showed that age≥70 years old,complicated with diabetes,COPD course≥5 years,high levels of TNF-α,INF-γ and lncRNA SNHG16 were risk factors for elderly patients with COPD complicated with PI(P<0.05),but high FEV1/FVC and high levels of SMAD4 and IL-10 were protective factors(P<0.05).Spearman correlation analysis showed that serum relative expression level of ln-cRNA SNHG16 was positively correlated with sCPIS in COPD patients with PI(r=0.505,P<0.001),while SMAD4 level was negatively correlated with sCPIS(r=-0.550,P<0.001).The area under the curve(AUC)of the combined diagnosis of serum lncRNA SNHG16 and SMAD4 for PI in elderly COPD patients was higher than those of individual diagnosis(Z=2.416,P=0.016;Z=2.375,P=0.018).Conclusion The serum relative expression level of lncRNA SNHG16 increases and SMAD4 level decreases in elderly COPD pa-tients with PI,both are influencing factors for elderly COPD patients complicated with PI,and both are related to the degree of PI in patients,and both have diagnostic value for elderly COPD patients complicated with PI,and the diagnostic efficacy of combined detection is better.

Objective:To analyze the safety and efficacy of ultrasound-guided percutaneous thermal ablation treatment for multiple T1N0M0 papillary thyroid carcinoma(PTC)with over 5 years follow-up.Methods:From January 2014 to January 2019,a retrospective analysis was conducted on patients with multiple T1N0M0 PTC who underwent ultrasound-guided thermal ablation.Patients with bilateral or unilateral lobes with isthmus PTC were enrolled in this study and were followed up at 1,3,6,12,24,36,48,and 60 months after ablation.The clinical data,ultrasound characteristics and ablation parameters of recurrent and non-recurrent patients were compared,and the efficacy and influencing factors of thermal ablation for multiple T1N0M0 PTC were analyzed.Results:After over 5 years follow-up,a total of 11 patients(16.18％)relapsed,57 patients(83.82％)did not re-lapse.No lymph node and distant metastasis were found.No significant correlation was detected between the recurrence and clinical features,ultrasound findings and ablation parameters(P＞0.05).Among the patients with recurrence,1 patient underwent observation,2 patients underwent total thyroidectomy,and the other 8 patients successfully underwent secondary ablation,all of which had no obvious adverse reactions.Conclusion:The ablation of multiple PTC in T1N0M0 stage is safe and effective,with a recurrence rate of 16.18％over 5 years follow-up,and ablation has no effect on second treatment for recurrent patients.

Objective:To assess the efficiency and safety of combining lenvatinib with DEB-TACE for the treatment of unresectable large hepatocellular carcinoma,accompanied by PVTT,in order to provide insights into its potential as a therapeutic approach.Method:Patients with hepa-tocellular carcinoma and portal vein tumor thrombus,who were diagnosed and treated at Linyi Can-cer Hospital between June 2019 and June 2021,were chosen as the subjects of this study.Patient allocation into the experimental group(23 cases)and control group(27 cases)was based on indi-vidual preferences,ensuring a random distribution of participants.The DEB-TACE treatment was administered to the control group,while the experimental group received a combination of DEB-TACE and lenvatinib.The effectiveness of lenvatinib was assessed in the immediate post-surgery period,the patients'survival was monitored,and any associated side effects were documented.Result:3 months after treatment,the objective remission rates of the experimental group and the control group were 91.31％and 66.67％,and the disease control rates were 100％and 77.78％.The difference was statistically significant(P＜0.05).3 months after treatment,the regression rates of tumor thrombus in the experimental group and the control group were 60.87％and 29.63％,the difference was statistically significant(P＜0.05).The progression free survival time of the experi-mental group and the control group was 11 months and 8 months,the difference was statistically significant(P＜0.05);The median survival time of the experimental group and the control group was 20 months and 14 months,and the difference was statistically significant(P＜0.05).The main ad-verse reactions of the experimental group were hypertension,diarrhea,hand foot syndrome,rash,fatigue,loss of appetite,etc.,all of which were less than or equal to grade 3,and could be basically relieved after symptomatic treatment.Conclusion:The combination of DEB-TACE and lenvatinib is proven to be a safe and well-tolerated treatment for unresectable large hepatocellular carcinoma with portal vein tumor thrombus.This therapy not only effectively controls tumor progression but also prolongs survival time.

ObjectiveTo explore the syndrome elements and evolving patterns of patients with hepatitis B virus-related acute on chronic liver failure （HBV-ACLF） at different stages. MethodsClinical information of 1,058 hospitalized HBV-ACLF patients， including 618 in the early stage， 355 in the middle stage， and 85 in the late stage， were collected from 18 clinical centers across 12 regions nationwide from January 1， 2012 to February 28， 2015. The “Hepatitis B-related Chronic and Acute Liver Failure Chinese Medicine Clinical Questionnaire” were designed to investigate the basic information of the patients， like the four diagnostic information （including symptoms， tongue， pulse） of traditional Chinese medicine （TCM）， and to count the frequency of the appearance of the four diagnostic information. Factor analysis and cluster analysis were employed to determine and statistically analyze the syndrome elements and patterns of HBV-ACLF patients at different stages. ResultsThere were 76 four diagnostic information from 1058 HBV-ACLF patients， and 53 four diagnostic information with a frequency of occurrence ≥ 5% were used as factor analysis entries， including 36 symptom information， 12 tongue information， and 5 pulse information. Four types of TCM patterns were identified in HBV-ACLF， which were liver-gallbladder damp-heat pattern， qi deficiency and blood stasis pattern， liver-kidney yin deficiency pattern， and spleen-kidney yang-deficiency pattern. In the early stage， heat （39.4%， 359/912） and dampness （27.5%， 251/912） were most common， and the pattern of the disease was dominated by liver-gallbladder damp-heat pattern （74.6%， 461/618）； in the middle stage， dampness （30.2%， 187/619） and blood stasis （20.7%， 128/619） were most common， and the patterns of the disease were dominated by liver-gallbladder damp-heat pattern （53.2%， 189/355）， and qi deficiency and blood stasis pattern （27.6%， 98/355）； and in the late stage， the pattern of the disease was dominated by qi deficiency （26.3%， 40/152） and yin deficiency （20.4%， 31/152）， and the patterns were dominated by qi deficiency and blood stasis pattern （36.5%， 31/85）， and liver-gallbladder damp-heat pattern （25.9%， 22/85）. ConclusionThere are significant differences in the distribution of syndrome elements and patterns at different stages of HBV-ACLF， presenting an overall trend of evolving patterns as "from excess to deficiency， transforming from excess to deficiency"， which is damp-heat → blood stasis → qi-blood yin-yang deficiency.

Objective China is among the 30 countries with a high burden of tuberculosis(TB)worldwide,and TB remains a public health concern.Kashgar Prefecture in the southern Xinjiang Autonomous Region is considered as one of the highest TB burden regions in China.However,molecular epidemiological studies of Kashgar are lacking. Methods A population-based retrospective study was conducted using whole-genome sequencing(WGS)to determine the characteristics of drug resistance and the transmission patterns. Results A total of 1,668 isolates collected in 2020 were classified into lineages 2(46.0%),3(27.5%),and 4(26.5%).The drug resistance rates revealed by WGS showed that the top three drugs in terms of the resistance rate were isoniazid(7.4%,124/1,668),streptomycin(6.0%,100/1,668),and rifampicin(3.3%,55/1,668).The rate of rifampicin resistance was 1.8%(23/1,290)in the new cases and 9.4%(32/340)in the previously treated cases.Known resistance mutations were detected more frequently in lineage 2 strains than in lineage 3 or 4 strains,respectively:18.6%vs.8.7 or 9%,P<0.001.The estimated proportion of recent transmissions was 25.9%(432/1,668).Multivariate logistic analyses indicated that sex,age,occupation,lineage,and drug resistance were the risk factors for recent transmission.Despite the low rate of drug resistance,drug-resistant strains had a higher risk of recent transmission than the susceptible strains(adjusted odds ratio,1.414;95%CI,1.023-1.954;P = 0.036).Among all patients with drug-resistant tuberculosis(DR-TB),78.4%(171/218)were attributed to the transmission of DR-TB strains. Conclusion Our results suggest that drug-resistant strains are more transmissible than susceptible strains and that transmission is the major driving force of the current DR-TB epidemic in Kashgar.

Objective To characterize the temporal dynamics of endophytic community and key metabolites during the growth developmental stages of Artemisia indica and to explore the effects of endophytes on the medicinal material quality of A.indica from the perspective of microorganism combined with the correlation analysis.Methods In this study,high-throughput sequencing was performed to obtain the temporal dynamics of diversity and composition of endophytic community during the growth stages of A.indica.Key metabolites quantitative analysis were performed using high-performance liquid chromatography and ultraviolet spectrophotometry.Spearman's correlation analysis was further conducted to identify the endophytic communities that were significantly correlated with metabolites.Results There were significant differences in the diversity and composition of endophytic communities during the growth stages of A.indica.Linear discriminant analysis efect size(LEfSe)analyses identified some potential microbial biomarkers,such as Firmicutes,Massilia,Pantoea,Alternaria,Didymella,and Trichomerium.The abundances of some genera were significantly and positively correlated with the content of total polyphenols and total flavonoids(P<0.05),such as Curtobacterium,Pantoea,Tilletiopsis,and Dissoconium.The abundances of Pseudozyma,Ralstonia,and Pleospora were significantly and positively correlated with Chlorogenic acid,Isochlorogenic acid B,Isochlorogenic acid A,and Isochlorogenic acid C(P<0.05).Conclusion This work described the distribution of endophytes and key metabolites during the development stages of A.indica.Some endophytic communities with significant correlation of key metabolites were identified,which provided valuable information to guide the isolation of endophytic strains related to key metabolites and improve the quality of A.indica.

Objective To investigate the efficacy of different approaches for screw internal fixation in the treatment of posterior ankle fractures in trimalleolar fracture,and the complications was analyzed.Methods A prospective study was conducted on 80 patients with Haraguchi type Ⅰ posterior ankle fracture who admitted to our hospital from May 2019 to October 2020,they were randomly divided into group A and group B according to a random number table method,with 40 cases in each group.Patients in group A were treated with percutaneous anterior to posterior screw internal fixation for posterior ankle fractures,while patients in group B were treated with percutaneous posterolateral approach limited exposure and reduction screw internal fixation for posterior ankle fractures.The surgical indicators,postoperative recovery,American Orthopaedic Foot and Ankle Society(AOFAS)score,ROM score of ankle joint at the last follow-up,postoperative evaluation,and postoperative complications of patients between the two groups were compared.Results There was no statistically significant difference in operation time,complete weight-bearing time,or fracture healing time of patients between the two groups(P>0.05),but the fluoroscopy times of patients in group A was less than that in group B,the intraoperative bleeding volume and fibular incision length were less/shorter than those in group B(P<0.05).The AOFAS scores of patients 6 months after surgery and at the last follow-up in both groups increased compared with those 3 months after surgery,and the AOFAS scores at the last follow-up were higher than those 6 months after surgery,the differences were statistically significant(P<0.05).The AOFAS scores of patients 6 months after surgery and at the last follow-up in group B were higher than those in group A(P<0.05).There was no statistically significant difference in ROM score of ankle joints(plantar flexion,valgus,varus,dorsiflexion)of patients between the two groups at the last follow-up(P>0.05).There was no statistically significant difference in poor screw position,degree of pain,walking condition,or squatting condition of patients between the two groups(P>0.05).However,the reduction quality of posterior ankle fractures of patients in group B was better than that in group A(Z=4.248,P<0.05).No complications such as loosening of internal fixation or loss of fracture reduction occurred in both groups.Conclusion Both percutaneous anterior to posterior screw internal fixation and percutaneous posterolateral approach limited exposure and reduction screw internal fixation have good efficacy for posterior ankle fractures in trimalleolar fracture,with high safty.The former has more fluoroscopy times and less intraoperative bleeding,while the latter is better in improving ankle joint function and fracture reduction.