ObjectiveTo evaluate the overall dietary intake of adult residents in Sijing Town, Songjiang District, Shanghai, and to explore the association between dietary health literacy and diet quality. MethodsA total of 1 280 adult residents were selected as the research subjects using a multi-stage sampling method, and face-to-face questionnaire surveys were administered on site. Dietary intake data were collected using a Food Frequency Questionnaire (FFQ), and the overall diet quality of the participants was evaluated based on the Chinese Healthy Eating Index (CHEI). Participants were divided into low- and high-CHEI groups according to the median CHEI score. Logistic regression models were used to examine the association between dietary health literacy and diet quality. ResultsThe median CHEI score for adults in the area was 63.68 points. Multivariate logistic regression analysis revealed that adults with lower dietary health literacy had lower CHEI scores and poorer overall diet quality compared to those with higher dietary health literacy (OR=1.435, 95%CI:1.132‒1.819). ConclusionThe overall diet quality of adult residents in this region requires improvement. There is a significant positive correlation between the level of dietary health literacy and CHEI scores, suggesting that enhancing dietary health literacy may be an important strategy to improve resident’ dietary quality.

Disruption of the intestinal mucosal barrier caused by gut dysbiosis and metabolic imbalance is the underlying pathology of inflammatory bowel disease (IBD). Traditional Chinese medicine Wuji Wan (WJW) is commonly used to treat digestive system disorders and showed therapeutic potential for IBD. In this interdisciplinary study, we aim to investigate the pharmacological effects of WJW against experimental colitis by combining functional metabolomics and gut-microbiota sequencing techniques. Treatment with WJW altered the profile of the intestinal microbiota and notably increased the abundance of Lactobacillus, thereby facilitating the conversion of tryptophan into indole-3-acetic acid (IAA) and indoleacrylic acid (IA). These indole derivatives activated the aryl hydrocarbon receptor (AhR) pathway, which reduced colonic inflammation and restored the expression of intestinal barrier proteins. Interestingly, the beneficial effects of WJW on gut barrier function improvement and tryptophan metabolism were disappeared in the absence of gut microbiota. Finally, pre-treatment with the AhR antagonist CH-223191 confirmed the essential role of IAA-mediated AhR activation in the therapeutic effects of WJW. Overall, WJW enhanced intestinal barrier function and reduced colonic inflammation in a murine colitis model by modulating Lactobacillus-IAA-AhR signaling pathway. This study provides novel insights into colitis pathogenesis and presents an effective therapeutic and preventive approach against IBD.

OBJECTIVES: To compare the efficacy of toric implantable collamer lens (Toric-ICL) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia correction in patients with moderate to high myopia complicated with astigmatism. METHODS: We retrospectively collected data from 64 patients (aged 18-42 years) with moderate to high myopia complicated with astigmatism (128 eyes) undergoing either Toric-ICL (28 patients/56 eyes) or FS-LASIK (36 patients/72 eyes) at our department between January, 2019 and December, 2020. The changes of uncorrected distance visual acuity (UCVA), spherical equivalent (SE), mean astigmatism correction index (CI), corneal endothelial cell density (ECD) and intraocular pressure (IOP) following the procedures were compared between the two groups. RESULTS: In FS-LASIK group, all the eyes (72/72) achieved an UCVA≥1.0, similar to the rate in Toric-ICL group (55/56 eyes; P=0.2374). The postoperative SE was also comparable between FS-LASIK and Toric-ICL groups [0.43±0.06 D (range: -1.0 to 1.50 D) vs 0.38±0.05 D (range: -0.75 to 1.00 D); P=0.56]. The mean astigmatism CI was significantly higher in FS-LASIK group than in Toric-ICL group (0.8561 vs 0.7176; P<0.0001), and 88.89% of the eyes in FS-LASIK group and 69.64% in Toric-ICL group had postoperative astigmatism ≤0.50 D. No significant changes were observed in postoperative corneal ECD in FS-LASIK group, whereas ECD decreased significantly after the procedure in Toric-ICL group (P=0.0057). The patients undergoing Toric-ICL exhibited no significant changes of postoperative IOP, but the patients receiving FS-LASIK had significantly reduced IOP after the procedure (P<0.001). CONCLUSIONS Although the patients included in Toric-ICL group had higher myopia and astigmatism, Toric-ICL still showed better predictability and efficacy for astigmatic correction in Toric-ICL group. Toric-ICL is an effective and safe equivalent of FS-LASIK for correcting moderate myopia but can be more advantageous for correcting high myopia with astigmatism.
Humans ; Astigmatism/complications* ; Myopia/complications* ; Keratomileusis, Laser In Situ/methods* ; Retrospective Studies ; Adult ; Visual Acuity ; Adolescent ; Young Adult ; Treatment Outcome ; Male ; Lens Implantation, Intraocular/methods* ; Female ; Phakic Intraocular Lenses ; Intraocular Pressure

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

Extended reality (XR) includes a variety of visualisation technologies such as virtual reality, augmented reality, and mixed reality. It refers to a combination of the real and the virtual entities through computers to create a virtual environment where human and computer can interact, characterized by immersion, interactivity, conceptualization, and combination of reality and fiction. Recently, great progress has been made in the application of XR in the fields of medical education, precision medicine, telemedicine, surgical assistance and navigation so that XR has drawn increasing attention. This paper briefly describes the concept of XR and its technological development, expounds its clinical application in orthopedics, surgery in particular, analyzes the existing problems and difficulties, and predicts its future development trend. This review may help readers gain a more comprehensive and in-depth understanding of the history, current status and future development of intelligent orthopaedics based on XR technology.

Objective To analyze the clinical characteristics of children with hand,foot and mouth disease(HFMD)infected with different enterovirus subtypes and construct a risk nomogram prediction model to provide basis for HFMD prevention and treatment.Meth-ods The clinical data of 346 cases of children hospitalized with HFMD in Shanxi Children's Hospital(Shanxi Maternal and Child Health Hospital)from 2017-2021 were collected and divided into Coxsackie virus A16 group(n=26),enterovirus 71 group(n=56)and en-terovirus general group(n=264)according to different enteroviruses,and the clinical characteristics were compared between the three groups to construct a risk nomogram model in children with HFMD combined with brainstem encephalitis to validate the prediction effect of the model.Results The age of children with HFMD was mainly distributed between 1 and 3 years(81.21％),with a male to female ra-tio of 1.56∶1,with a primary peak of incidence in June to August and a secondary peak in October to November,with enterovirus 71 type infections predominating in 2017 and enterovirus general infections in 2018-2021.The differences were statistically significant in age,days of hospitalization,presence of fever,fever typing,days of fever duration,herpes,maculopapular rash,oral rash,knee rash,white blood cell,platelet count,C-reactive protein and procalcitonin among the three groups(P＜0.05).The occurrence of HFMD combined with brainstem encephalitis in children was positively correlated with longer days of hospitalization and fever duration,papular rash and en-terovirus 71 positivity,and negatively correlated with longer days of rash(P＜0.05).The nomogram model showed that the probability of occurrence of childhood HFMD combined with brainstem encephalitis was 85.6％,the area under the receiver operating characteristic curve was 0.860.The calibration curve showed that the actual probability was in good agreement with the predicted probability,and the decision curve showed that the net gain of the model essentially to the full threshold probability was obvious.Conclusion HFMD in chil-dren has obvious seasonality with double peaks,enterovirus general type is the dominant pathogen of HFMD in recent years,the clinical characteristics of infection with different enteroviruses are different,the risk nomogram model has good early prediction effect on HFMD combined with brainstem encephalitis in children,and has high clinical application value,which is important for the prevention,diagnosis and treatment of HFMD in children.

OBJECTIVE: To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees. METHODS: Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR. RESULTS: TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations. CONCLUSION TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.
Humans ; Artificial Limbs ; Muscle, Skeletal ; Neurosurgical Procedures ; Plastic Surgery Procedures ; Prosthesis Implantation

ObjectiveTo investigate the willingness of rehabilitation patients within an urban medical group to accept downward referrals and analyze the influencing factors. MethodsFrom June to October, 2023, a survey was conducted using a simple random sampling method among neurological and orthopedic rehabilitation patients in hospitals within a specific urban medical group. The 2013 version of the Andersen Model was employed to construct a theoretical framework for the willingness of rehabilitation patients to accept downward referrals and influencing factors. Within this framework, a questionnaire was designed using a 5-point Likert scale, comprising three sections including personal characteristics, environmental features and healthcare service utilization choices, totaling 23 questions. A preliminary survey was conducted, and the questionnaire had underwent reliability and validity testing. ResultsA total of 350 questionnaires were collected, with 314 valid questionnaires. The willingness of rehabilitation patients to accept downward referrals was found to be associated with age, rehabilitation specialties, rehabilitation phases, previous experiences with downward referrals, awareness of and perceptions regarding bidirectional referral policies, and understanding and opinions about the urban medical group (χ² > 7.755, P < 0.05). The primary influencing factors were rehabilitation specialties, rehabilitation phases, previous experiences with downward referrals and perceptions of the necessity of bidirectional referral policies (P < 0.05). ConclusionRehabilitation specialties, rehabilitation phases, previous experiences with downward referrals and perceptions of the necessity of bidirectional referral policies are the primary factors that influenced the willingness of rehabilitation patients to accept downward referrals. We should formulate targeted and focused improvement measures based on the specific circumstances and key influencing factors of rehabilitation patients within the urban medical group regarding their willingness to accept downward referrals. Continuously enhancing the proportion of patients willingness to accept downward referrals is essential for the effective implementation of bidirectional referral for rehabilitation patients.

Objective:To observe the temporal variability of functional connectivity between the bilateral inferior frontal gyrus and rest of the brain in persons with Broca′s aphasia (BA) and to compare the connectivity between Uygur and Chinese aphasics.Methods:Thirty Chinese and Uygur BA patients (the patient group) and 30 healthy people speaking Uygur and Chinese (the healthy group) were included. rs-fMRI images were acquired, and the patient group was divided then into a Uygur language patient group (9 cases) and a Chinese language patient group (12 cases). The healthy group was divided into a Uygur language healthy group (13 cases) and a Chinese language healthy group (15 cases). Dynamic functional connectivity (dFC) calculations were performed, and a two-factor analysis of covariance was used to obtain the brain regions in which there was an interaction between language and aphasia and to analyze the correlation between the brain regions with abnormal dFCs and linguistic behavior.Results:Interaction between the bilateral inferior frontal gyrus and the left medial and paracentral cingulate gyrus and the right postcentral gyrus dFC was observed to vary. Temporal variability among the Uygur patients was significantly less than among the Uygur healthy and Chinese patient groups. The temporal variability of Broca′s mirror area and the right postcentral gyrus in the Chinese patient group was significantly greater than in the Chinese healthy group or the Uygur patient group. Variability of Broca′s area and the left medial and paracingulate cingulate gyrus in the Uygur patients group correlated positively with oral fluency, reading comprehension and writing.Conclusion:There are differences in the temporal variability of the dFC in the bilateral inferior frontal gyrus between Uygur and Chinese BA patients. The lower variability of Broca′s area with the left medial and paracingulate and cingulate gyrus may help to identify impaired language function in BA patients. The enhanced variability of the Broca′s mirror image area with the right postcentral gyrus may be the result of reorganization of the linguistic network in Chinese BA patients.

Objective:To explore the current situation of hypoglycemia fear of elderly patients with type 2 diabetes mellitus (T2DM) in the community, identify different types of hypoglycemia fear among elderly T2DM patients in the community by latent profile analysis, and analyze its influencing factors, so as to provide reference for formulating intervention measures.Methods:From February to April 2023, convenience sampling was used to select 300 elderly T2DM patients from three community health service centers in Shunqing District, Nanchong City, Sichuan Province as the research subject. The self-designed General Information Questionnaire, the Chinese Version Hypoglycemia Fear Survey-Ⅱ (CHFS-Ⅱ), and the Summary Diabetes Self Care Activities (SDSCA) were used to investigate the patients, and the latent profile of hypoglycemia fear was analyzed. Binary Logistic regression was used to analyze the influencing factors of different latent categories of hypoglycemic fear in elderly T2DM patients in the community.Results:A total of 300 questionnaires were distributed, and 290 valid questionnaires were collected, with an effective response rate of 96.7% (290/300). Among 290 elderly T2DM patients in the community, the hypoglycemia fear could be divided into two latent categories, including the "moderate worry-normal coping" group ( n=134) and the "high fear-cautious behavior" group ( n=156). The binary Logistic regression showed that marital status, whether there were complications of diabetes, treatment plan and self-management were the factors influencing the latent categories of elderly T2DM patients in the community, and the difference was statistically significant ( P<0.05) . Conclusions:There are classification characteristics of hypoglycemic fear levels in elderly T2DM patients in the community. Community medical and nursing staff should early identify patients in the "high fear-cautious behavior" group, regularly carry out targeted hypoglycemic health education and psychological intervention, reduce their hypoglycemic fear, and improve their quality of life.