BACKGROUND:Kinesio taping is often used for the treatment of various sports injuries.The methods of foot and ankle sports taping are complex and diverse.Among them,Fascia taping is applicable to a wider range of people and can be used for different foot posture types,but it still lacks of practical verification,and its specific biomechanical role is not clear. OBJECTIVE:To observe the changes in plantar pressure characteristics of subjects with different foot positions during walking and jogging after Fascia taping. METHODS:Thirty-seven young healthy subjects were recruited from the Yantai campus of Binzhou Medical University to conduct the test.They were scored according to the foot posture index-six items version,and were divided into the supination foot group,the neutral foot group,and the pronation foot group.The static foot morphological indexes(including navicular drop,arch height index,arch height flexibility-longitudinal arch,and arch height flexibility-transverse arch)and the pressure-time integral of each foot zone during walking and jogging were collected and calculated respectively before and after Kinesio taping.The specific biomechanical mechanism of Fascia taping was analyzed. RESULTS AND CONCLUSION:(1)General data:There was no statistical difference among the three groups of subjects in general data,such as gender,height,and body mass index(P>0.05).Before taping,there was a significant difference in the foot morphological indexes and the areas of the outer front foot,midfoot,and hindfoot between different foot posture groups(P<0.01).(2)Static foot morphological indexes:After taping,there was no statistically significant difference between the groups in navicular drop,arch height flexibility-longitudinal arch,and arch height flexibility-transverse arch(P>0.05),while there was still a significant difference between the groups in the arch height index(P<0.05).In the supination foot group,the arch height index increased slightly,but there was no significant difference before and after taping(P>0.05).In the pronation foot group,the navicular drop and arch height flexibility-longitudinal arch was significantly reduced,and the arch height index was increased.There was a significant difference before and after taping(P<0.05).(3)The index of plantar pressure during walking:After taping,there was no significant difference between the three groups in the area of lateral forefoot and medial midfoot(P>0.05).In the pronation foot group,the lateral load of the forefoot increased after taping(P<0.05).In the supination position group,the load of the lateral forefoot and midfoot regions increased significantly(P<0.05),while the difference in the rear foot region was not significant(P>0.05).(4)The index of plantar pressure during jogging:After taping,there was no statistically significant difference between groups in the lateral forefoot(P>0.05).In the pronation foot group,the load of the medial forefoot increased significantly(P<0.05).In the supination position group,the load of the lateral forefoot,the middle foot and the rear foot region increased significantly(P<0.05).(5)The results showed that the Fascia taping was suitable for different foot postures.It could not only correct the static foot structure of subjects with different foot postures,but also regulate the abnormal plantar pressure distribution during the dynamic activities of walking and jogging,and the load of the midfoot,forefoot,and hindfoot in the supination and pronation posture tended to normal foot posture load level.

BACKGROUND:With social progress,the incidence rate of knee osteoarthritis is getting higher and higher in the face of the rapidly developing aging problem in the social population,and the number of total knee replacement operations is gradually increasing. OBJECTIVE:To study the relationship between prosthesis size and stress shielding by improving the tibial prosthesis base. METHODS:A female patient with severe knee osteoarthritis was selected.Based on Mimics,through extracting the bone structure of the knee joint and simulating the total knee replacement surgery,osteotomy,positioning,and implantation operations were carried out to establish the geometric modeling of the total knee replacement prosthesis(including the femoral prosthesis,tibial bracket,and tibial pad),and improve the design of the tibial prosthesis base,analyze the effect of different tibial prosthesis bases on stress shielding of surrounding bone tissue. RESULTS AND CONCLUSION:(1)Compared with single-stem tibial intramedullary stem prosthesis,the design of four-post tibial intramedullary stem prosthesis created a certain degree of stress shielding around the short stem.However,compared with a thicker single long stem,this stress shielding effect was significantly reduced,and the load was evenly distributed among the four short stems,so there was no stress concentration at the bottom of the pile.(2)The design with a rectangular hole in the middle not only provided relatively good stability,but also helped to reduce stress shielding of cancellous bone to a certain extent,with a reduction rate of 77.5%.(3)Compared with a single-stem tibial intramedullary stem prosthesis,both the four-post tibial intramedullary stem prosthesis and the four-post tibial intramedullary stem prosthesis with a hole in the middle have good stability,which can reduce stress shielding to a certain extent without causing stress concentration,providing theoretical guidance for the design of the tibial intramedullary stem.

BACKGROUND:During stair walking,different muscles work in concert and compensate for each other,and it is unclear whether weakened muscle strength actually affects stair fall risk in older adults.Real-time electromyographic signals from older adults during stair walking are used to reflect high fall risk in older adults during stair walking,which may further improve the accuracy of prediction methods. OBJECTIVE:To investigate the effects of aging on lower limb muscle activation in older adults during stair walking and to analyze the relationship between their muscle activation characteristics and stair fall risk. METHODS:Subjects were divided by age into an older group(n=19)and a younger group(n=18)group and were asked to walk on a 10-step staircase at a natural speed,incorporating surface electromyography acquisition technology,to capture surface electromyography signals during stair walking and calculate the root mean square(RMS)to analyze differences in muscle activation levels.Logistic regression analysis was utilized to establish a predictive model for stair fall risk in older adults by incorporating the lateral femoral and gastrocnemius muscle RMS.The discrimination of the model was evaluated by the receiver operating characteristic curve and area under the curve,and the fit of the model was evaluated using the Hosmer-Lemeshow test RESULTS AND CONCLUSION:Activation of the rectus femoris(Z=-3.464,P=0.001;t=3.379,P=0.002)and lateral gastrocnemius muscle(Z=-2.978,P=0.003;Z=-3.555,P<0.001)was higher in older adults than in younger adults when walking up and down stairs.Activation of the anterior tibialis(Z=-2.350,P=0.019)and medial(Z=2.321,P=0.020)and lateral(t=3.158,P=0.004)gastrocnemius muscles was higher in older adults when ascending stairs than descending stairs.Older adults at risk for falls had less activation of the lateral femoral muscle(Z=-2.613,P=0.009),medial gastrocnemius muscle(Z=-2.286,P=0.022)when walking upstairs,and lateral femoral muscle(Z=-2.368,P=0.018)when walking downstairs than did older adults not at risk for falls.The predictive ability,goodness of fit,and discrimination of the stair fall prediction model for older adults based on surface electromyography were good(P-value of 0.010 for the Omnibus test of the model coefficients,P-value of 0.214 for the Hosmer-Lemeshow test,and the area of the curve of the upper staircase lateral femoral muscle=0.856,P=0.009).(5)The model was modeled with a cut-off value of 38.64 for the upper staircase lateral femoral muscle RMS value and there was a 0.952-fold increase in the risk of staircase falls for each unit decrease in the upper staircase lateral femoral muscle RMS in older adults.

With the increasing incidence of cardiovascular diseases,Professor WANG Yongyan has adhered to the traditional principles while embracing innovation,proposing to apply the theory of"the heart governing the spirit"to the prevention and treatment of cardiovascular diseases.He emphasized that it is crucial to preserve the spirit before the onset of disease,which includes maintaining a balanced diet,regular lifestyle,avoiding excessive labor,maintaining a serene and unfettered mind,and nurturing the spirit within.For those already suffering from disease,preventing progression and deterioration requires adjusting the spirit,and skilled practitioners should first inspect the patient's spirit by examining the eyes,tongue,facial complexion,and overall physical condition.In treatment,adjusting the spirit involves distinguishing between different imbalances of qi,blood,yin,yang,cold,heat,deficiency,and excess,and employing appropriate method to calm and nourish the spirit accordingly.After the illness,nurturing the spirit is essential,including spiritual nourishment through exercise,dietary therapy,emotional therapy,and external treatments.By applying the theory of"the heart governing the spirit"throughout the prevention,treatment,and rehabilitation of cardiovascular diseases,Professor WANG Yongyan's approach effectively prevents the occurrence of cardiovascular diseases,controls their progression,inhibits deterioration,and improves the prognosis of patients.

Objective To establish the reference intervals of neutrophil to lymphocyte ratio(NLR),mono-cyte to lymphocyte ratio(MLR)and platelet to lymphocyte ratio(PLR)in different genders and age groups in northern Chinese adults.Methods The data were analyzed according to the Clinical and Laboratory Stand-ards Institute C28-A3.Outliers were checked and judged according to the Dixon method.Subgroups were di-vided according to gender or age factors,and reference intervals were established for different subgroups.Ref-erence intervals were expressed as two-sided 95％percentiles.Results The reference intervals of NLR,MLR and PLR were 0.90-3.82,0.09-0.33 and 71.20-246.87,respectively.The results showed that NLR and PLR in men were lower than those in women(P＜0.001),while MLR in men was significantly higher than that in women(P＜0.001).Linear trend plots showed that NLR,MLR and PLR changed significantly in dif-ferent genders and age groups.In men,NLR and MLR increased with age,while PLR gradually increased and reached the peak before 50 years old,and gradually decreased after 50 years old.In women,NLR and MLR showed the lowest values at 50-＜60 years old,while PLR reached the peak at about 50 years old.The refer-ence intervals established by the model set were verified,and the percentages beyond the reference intervals were less than 10％in different genders and age groups.Conclusion The reference intervals of NLR,MLR and PLR in different genders and age groups of healthy adults in northern China are established in the study.

In the era of evidence-based medicine, it is necessary to explore the unique advantages of traditional Chinese medicine (TCM) based on standardized technical methods and operating procedures in order to achieve the modernization and internationalization of TCM and benefit all humanity. The proposal of a three-pronged evidence system combining TCM theory, human experience and experimental evidence marks an important progress in the thinking method of the TCM evaluation system. The multi-evidence body integrated through appropriate methods provides a strong support for the clinical guideline recommendations and evidence-based health decision-making in TCM. Based on the current methodological progress of international evidence synthesis and grading, this paper proposes a novel approach for integrating multi-evidence in TCM: the MERGE framework. The aim is to establish a solid foundation for the development of this methodology and provide guidance for the advancement of evidence-based medicine framework in TCM.

Objective:To investigate the risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity patients with concomitant osteoporosis undergoing long-segment spinal fusion surgery.Methods:A retrospective analysis was conducted on 76 adults spinal deformity patients with osteoporosis who underwent long-segment spinal fusion surgery at the Department of Orthopaedics, Beijing Chaoyang Hospital, between June 2013 and December 2019. The cohort included 19 males and 57 females, with a mean age of 66.26±6.10 years (range, 54-78 years). Patients were categorized into two groups based on the occurrence of PJK within a 2-year postoperative follow-up: the PJK group (21 cases) and the non-PJK group (55 cases). Comparative analyses were performed on baseline characteristics, surgical details, preoperative and postoperative spinal-pelvic parameters, Hounsfield Units (HU) of the vertebral bodies, and paraspinal muscle morphology between the groups. Spinal-pelvic parameters included the main Cobb angle, lumbar lordosis (LL), lumbosacral lordosis (LSL), sagittal vertical axis (SVA), T 1 pelvic angle (TPA), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). Preoperative CT was used to measure HU values at the upper instrumented vertebra (UIV), UIV+1, and UIV+2. Paraspinal muscle morphology, including the relative functional cross-sectional area (rFCSA) and functional muscle-fat index (FMFI) at the L 4 lower endplate level, was assessed using preoperative MRI. Optimal cutoff values for HU and paraspinal muscle parameters were determined using receiver operating characteristic curve analysis. Multivariable logistic regression was employed to identify independent risk factors for PJK. Results:Significant differences were observed between the PJK and non-PJK groups in preoperative PT (17.60°±8.39° vs. 24.12°±9.37°), postoperative LL (35.61°±10.62° vs. 42.22°±13.11°), LSL (30.24°±10.10° vs. 35.87°±11.12°), and SVA (37.82°±20.46° vs. 21.37°±17.35°). The differences were statistically significant ( P<0.05). The HU values of UIV (113.62±17.25 vs. 133.94±16.61), UIV+1 (123.14±16.03 vs. 138.27±13.69), and UIV+2 (121.00±15.91 vs. 134.47±15.53) were significantly lower in the PJK group ( P<0.05). Optimal cutoff values for HU at UIV, UIV+1, and UIV+2 were identified as 120.72, 127.51, and 121.50, respectively. Significant differences were also found in rFCSA (156.87±48.06 vs. 204.87±50.16) and FMFI (0.31±0.10 vs. 0.23±0.09). The differences were statistically significant( P<0.05), with optimal cutoff values of 175.43 for rFCSA and 0.24 for FMFI. Multivariable logistic regression analysis indicated that postoperative SVA [ OR=1.049, 95% CI (1.003, 1.097), P=0.037], HU of UIV [ OR=0.938, 95% CI (0.887, 0.991), P=0.024], and rFCSA of paraspinal muscles [ OR=0.883, 95% CI (0.792, 0.983), P=0.023] were independent risk factors for PJK. Conclusion:Reduced HU values of the UIV, decreased rFCSA of lumbar paraspinal muscles, and inadequate sagittal alignment correction are independent risk factors for PJK in adult spinal deformity patients with osteoporosis undergoing long-segment spinal fusion surgery.

Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment landscape for chronic myeloid leukemia (CML). However, TKI resistance poses a significant challenge, leading to treatment failure and disease progression. Resistance mechanisms include both BCR::ABL1-dependent and BCR::ABL1-independent pathways. The mechanisms underlying BCR::ABL1 independence remain incompletely understood, with CML cells potentially activating alternative signaling pathways, including the AKT/mTOR and JAK2/STAT5 pathways, to compensate for the loss of BCR::ABL1 kinase activity. This study explored tumoral VISTA (encoded by VSIR) as a contributing factor to TKI resistance in CML patients and identified elevated tumoral VISTA levels as a marker of resistance and poor survival. Through in vitro and in vivo analyses, we demonstrated that VSIR knockdown and the application of NSC-622608, a novel VISTA inhibitor, significantly impeded CML cell proliferation and induced apoptosis by attenuating the AKT/ mTOR and JAK2/STAT5 pathways, which are crucial for CML cell survival independent of BCR::ABL1 kinase activity. Moreover, VSIR overexpression promoted TKI resistance in CML cells. Importantly, the synergistic effect of NSC-622608 with TKIs offers a potent therapeutic avenue against both imatinib-sensitive and imatinib-resistant CML cells, including those harboring the challenging T315I mutation. Our findings highlight the role of tumoral VISTA in mediating TKI resistance in CML, suggesting that inhibition of VISTA, particularly in combination with TKIs, is an innovative approach to enhancing treatment outcomes in CML patients, irrespective of BCR::ABL1 mutation status. This study not only identified a new pathway contributing to TKI resistance but also revealed the possibility of targeting tumoral VISTA as a means of overcoming this significant clinical challenge.

ObjectiveTo explore the effect of core stability training on dynamic balance and surface electromyography (sEMG) after anterior cruciate ligament reconstruction (ACLR), and to analyze the correlation between balance index and sEMG. MethodsFrom March to December, 2022, 32 patients with ACLR in Yantai Affiliated Hospital of Binzhou Medical University were randomly divided into control group (n = 16) and experimental group (n = 16). The control group accepted routine rehabilitation treatment, and the experimental group added core stability training, for six weeks. They were evaluated with American Hospital for Special Surgery Knee Score (HSS) and International Knee Documentation Committee Knee Score (IKDC), and the dynamic balance function and sEMG were measured before and after treatment, and the correlation between dynamic balance index and root mean square (RMS) of sEMG was analyzed. ResultsAfter treatment, the scores of HSS and IKDC increased significantly in both groups (|Z| > 3.526, |t| > 63.544, P < 0.001), and were better in the experimental group than in the control group (Z = -2.392, t = 2.650, P < 0.05); the length of gait line and single support line increased significantly, the medial-lateral displacement displacement decreased (|t| > 2.368, Z = -3.516, P < 0.05), and they were better in the experimental group than in the control group (|t| > 2.497, Z = -3.091, P < 0.05); the RMS of gluteus maximus and gluteus medius increased in the experimental group (t = -5.900, Z = -2.741, P < 0.01), and were better than those in the control group (t = 3.930, Z = -3.260, P < 0.01). After treatment, the RMS of gluteus maximus and gluteus medius in both groups were positively correlated with gait line length and single support line length, and were negatively correlated with medial-lateral displacement (|r| > 0.502, P < 0.01). ConclusionCore stability training could significantly improve knee joint function and dynamic balance, and enhance the activation of gluteus maximus and gluteus medius. Dynamic balance is highly correlated with sEMG.

Objective:To analyze the compliance with enhanced recovery after surgery (ERAS) protocol in geriatric patients with fresh fracture.Methods:A retrospective study was conducted on the data of the patients with fresh extremity fracture which had been included in the ERAS perioperative protocol database during May 2019 and January 2022 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. The patients ≥65 years were selected as a study group which was matched by a control group of the patients < 65 years in sex, fracture type and date frame of hospitalization at a ratio of 1∶1. The 2 groups were compared in the compliance with the 14 ERAS core perioperative elements.Results:The study group and the control group each included 66 patients who were matched in sex and fracture type. 62.1% (41/66) of the patients in the study group had combined diseases, significantly more than that [16.7% (11/66)] in the control group( P<0.001). Altogether, the compliance with the 14 ERAS core perioperative elements was 78.6 (71.4, 85.7) % in both groups, showing no significant difference between them ( P>0.05). Respectively, the compliance with the postoperative oral intake in the study group (80.3%, 53/66) was significantly lower than that in the control group (92.4%, 61/66) ( P<0.05); the compliance with the other 13 elements showed no statistically significant difference between the 2 groups ( P>0.05). Conclusion:The ERAS perioperative protocol can be carried out smoothly in geriatric patients with fresh fracture whose compliance may be comparable to that of the none-elderly patients.