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Background Sarcopenia and osteoporosis are common diseases that predominantly affect older individuals. The interaction between muscle and skeleton exerts pivotal roles in bone remodeling. This study aimed to explore the function of myoblast-derived exosomal Prrx2 in osteogenic differentiation and its potential mechanisms. Methods Exosomes were isolated from myogenic differentiated C2C12 cells. qRT-PCR and Western blotting were used to determine target molecule expression. Osteogenic differentiation of BMSCs was evaluated by Alizarin red staining, ALP activity and levels of OCN, OPN, RUNX2, and BMP2. Dual-luciferase reporter assay, RIP, and ChIP assays were performed to verify the interaction between molecules. The nuclear translocation of YAP1 was observed by immunofluorescence staining. In vivo osteoporotic model was established by ovariectomy in mice. Bone loss was examined using HE staining. Results Prrx2 expression was elevated in myogenic differentiated C2C12 cells and their exosomes. Myoblast-derived exosomal Prrx2 enhanced osteogenic differentiation of BMSCs. Delivering exosomal Prrx2 directly bond to MIR22HG promoter and promoted its transcription and expression. MIR22HG enhanced expression and nuclear translocation of YAP via sponging miR-128, thus facilitating BMSC osteogenic differentiation. Knockdown of exosomal Prrx2 suppressed osteogenic differentiation, which could be abolished by MIR22HG overexpression. Similarly, miR-128 inhibitor or YAP overexpression reversed the inhibitory effect of MIR22HG depletion or miR-128 mimics on osteogenic differentiation. Finally, myoblast-derived exosomal Prrx2 alleviated osteoporosis in mice via up-regulating MIR22HG and activating the Hippo pathway. Conclusion Myoblast-derived exosomal Prrx2 contributes to transcriptional activation of MIR22HG to activate YAP pathway via sponging miR-128, thereby facilitating osteogenic differentiation of BMSCs.

Background Health equity has persistently been a global concern. How to fairly and appropriately allocate health resources is a research hotspot. While Western China is relatively backward economically and presents difficulties for the allocation of health resources, little attention has been given to the equity of resource allocation there. This study analysed the equity of allocation of beds, physicians and nurses in Western China from 2014-2018 to provide targeted guidance for improving the equity of health resource allocation. Methods Data for 2014-2018 obtained from the Statistical Yearbook (2015-2019) of provinces (autonomous regions and municipalities) were used to analyse health resource allocation in terms of beds, physicians and nurses in Western China. The Lorenz curve and Gini coefficient were calculated to evaluate equity in the population dimension and geographic dimension. The Theil index was used to measure the inequity of the three indicators between minority and nonminority areas. Results The number of beds, physicians and nurses in Western China showed an increasing trend from 2014-2018. The Lorenz curve had a smaller curvature in the population dimension than in the geographic dimension. The Gini coefficients for health resources in the population dimension ranged from 0.044 to 0.079, and in the geographic dimension, the Gini coefficients ranged between 0.614 and 0.647. The above results showed that the equity of health resource allocation was better in the population dimension than in the geographic dimension. The Theil index ranged from 0.000 to 0.004 in the population dimension and from 0.095 to 0.326 in the geographic dimension, indicating that the inequity in health resource allocation was higher in the geographic dimension. The intergroup contribution ratios of the Theil index in both the population and geographic dimensions were greater than 60%, indicating that the inequity in resource allocation was mainly caused by intergroup differences, namely, the allocation of health resources within the province. Among them, the inequity of physicians and nurses allocation was the most obvious. Conclusions From 2014 to 2018, the total amount of health resources have improved in Western China. However, health resource allocation in Western China was still inequitable in the population and geographic dimensions, and the inequity of health resource allocation in the geographic dimension showed a tendency to worsen. Meanwhile, although the inequity of human recourse allocation was alleviated in 2018 compare with 2014, the inequity of human resource distribution within provinces was still obvious. The government can increase the number of health resources and improve the accessibility of health resources by increasing financial investment, strengthening humanistic care for health workers, and establishing internet hospitals.

Background Online interest could serve as critical sentinel indicators for monitoring assisted reproductive technology (ART) demands, detecting regions with access inequities, and identifying shortcomings in policy frameworks; however, global online interest of ART has not been assessed. The study aims to investigate the spatiotemporal evolution of online interest in ART globally. Methods The study follows retrospective observational design. Data were derived from Google Trends and Relative Search Volume (RSV) data across 230 countries and regions were collected. After quality control, data from 59, 76, 69, and 61 countries and regions were included for different search terms (“Assisted reproductive technology,” “In vitro fertilization,” “Intracytoplasmic sperm injection,” and “Preimplantation genetic diagnosis,” respectively). Weekly percentage changes (WPCs) and annual percentage changes (APCs) were used to quantify the temporal variations in online interest. Results Globally, public online interest in ART demonstrated a distinct seasonal fluctuation, peaking during months 3–5 and 9–11, while declining in months 6–8 and 12 − 2. The global online interest showed a significant downward trend (APC = -11.22%, 95% Confidence Interval [CI]: -18.44 to -8.61) from 2004 to 2011, followed by a gradual increase from 2011 to 2016 (APC = 1.76%, 95% CI: -7.64 to 11.99). Interest then rapidly increased from 2016 to 2019 (APC = 27.24%, 95% CI: 12.48 to 35.20), before continuing to decline after 2020 (APC = -6.54%, 95% CI: -12.52 to -3.05) with predictions indicating further decreases by 2030. Overall, Europe exhibited relatively higher online interest, while Africa and Oceania showed lower levels. In Europe, France (RSV = 76), Italy (RSV = 66), and Spain (RSV = 32) had notable interest in ART. Whereas, in Oceania and Africa, Australia (RSV = 8), New Zealand (RSV = 6), Tunisia (RSV = 16), Algeria (RSV = 16), and Nigeria (RSV = 10) showed lower levels of interest. Israel, Réunion (France), and France ranked as the top three countries or regions with the highest online interest in ART worldwide. Conclusions Global online interest in ART shows significant variation across countries and regions, with a decline after 2020. To address these trends, ART resources and services should be allocated effectively based on seasonal and regional demand. Government action is needed to raise social awareness and improve the accessibility and utilization of ART.

Traditional Chinese medicine (TCM) hasbeen widely used to treat various diseases in China for thousands of years and has shown satisfactory effectiveness. However, many surveys found that TCM receives little recognition from Western medicine (WM) physicians and students. At present, TCM is offered as a compulsory course for WM students in WM schools. This study aimed to investigate whether TCM courses can affect the WM students' attitude toward TCM. WM students from Xiangya Medical School were invited to completeaweb-based questionnaire before and immediately after a TCM course. Their attitude toward TCM and treatment preferences for different kinds of diseases were tested. The Attitude Scale of TCM (ASTCM) was used. The main part of the ASTCM was designed to measure the attitude of medical students towardTCM. It consisted of 18 items, divided into cognitive dimension (5 terms), emotional dimension (8 terms), and behavioral tendencyfactor (5 terms). Finally, the results of 118 five-year program (FYP) and 36 eight-year program (EYP) students were included. For FYP students, there was a significant increase in the total mean score (66.42, SD 7.66 vs 71.43, SD 7.38;P<.001) of ASTCM after the TCM course. Significant increases in mean scores of the 3 factors of attitude (cognition: 21.64, SD 2.08 vs 22.90, SD 1.94; affection: 25.21, SD 4.39 vs 27.96, SD 4.4; and behavioral tendency: 19.577, SD 3.02 vs 20.58, SD 2.76; P<.001)were also observed. Except for the score of behavioral tendency (17.50, SD 3.54 vs 18.78, SD 3.22; P=.02), a significant increase was not detected in total score, cognition, and affection in EPY students (total score: mean 60.36, SD 10.53 vs mean 62.92, SD 10.05; cognition: mean 20.50, SD 2.73 vs mean 20.69, SD 2.73; and affection: mean 22.36, SD 6.32 vs mean 23.44, SD 5.84; all P>.05). The treatment preference of FYP students in acute (P=.02), chronic (P=.003), and physical diseases (P=.02) showed remarkable change. A major change was also detected in internal diseases (P=.02), surgical diseases (perioperative period; P=.01), and mental illnesses (P=.02) in EYP students. This change mainly appeared as a decline in WM preference and an increase in TCM and WM preference. The study showed that earlier exposure to the TCM course increased the positive attitude toward TCM in students majoring in WM. The results provide some suggestions for arraging TCM courses in WM schools.

Physical layer secret key generation (PLKG) is a promising technology for establishing effective secret keys. Current works for PLKG mostly study key generation schemes in ideal communication environments with little or even no signal interference. In terms of this issue, exploiting the reconfigurable intelligent reflecting surface (IRS) to assist PLKG has caused an increasing interest. Most IRS-assisted PLKG schemes focus on the single-input-single-output (SISO), which is limited in future communications with multi-input-multi-output (MIMO). However, MIMO could bring a serious overhead of channel reciprocity extraction. To fill the gap, this paper proposes a novel low-overhead IRS-assisted PLKG scheme with deep learning in the MIMO communications environments. We first combine the direct channel and the reflecting channel established by the IRS to construct the channel response function, and we propose a theoretically optimal interaction matrix to approach the optimal achievable rate. Then we design a channel reciprocity-learning neural network with an IRS introduced (IRS-CRNet), which is exploited to extract the channel reciprocity in time division duplexing (TDD) systems. Moreover, a PLKG scheme based on the IRS-CRNet is proposed. Final simulation results verify the performance of the PLKG scheme based on the IRS-CRNet in terms of key generation rate, key error rate and randomness.

Background For patients with multilevel degenerative cervical myelopathy, laminectomy and posterior cervical fusions (PCF) with instrumentation are widely accepted techniques for symptom relief. However, hardware failure is not rare and results in neck pain or even permanent neurological lesions. There are no in-depth studies of hardware-related complications following laminectomy and PCF with instrumentation. Methods The present study was a retrospective, single centre, observational study. Patients who underwent laminectomy and PCF with instrumentation in a single institution between January 2019 and January 2021 were included. Patients were divided into hardware failure and no hardware failure group according to whether there was a hardware failure. Data, including sex, age, screw density, end vertebra (C7 or T1), cervical sagittal alignment parameters (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, T1 slope, Cervical lordosis correction), regional Hounsfield units (HU) of the screw trajectory and osteoporosis status, were collected and compared between the two groups. Results We analysed the clinical data of 56 patients in total. The mean overall follow-up duration was 20.6 months (range, 12–30 months). Patients were divided into the hardware failure group (n = 14) and no hardware failure group (n = 42). There were no significant differences in the general information (age, sex, follow-up period) of patients between the two groups. The differences in fusion rate, fixation levels, and screw density between the two groups were not statistically significant (p > 0.05). The failure rate of fixation ending at T1 was lower than that at C7 (9% vs. 36.3%) (p = 0.019). The regional HU values of the pedicle screw (PS) and lateral mass screw (LMS) in the failure group were lower than those in the no failure group (PS: 267 ± 45 vs. 368 ± 43, p = 0.001; LMS: 308 ± 53 vs. 412 ± 41, p = 0.001). The sagittal alignment parameters did not show significant differences between the two groups before surgery or at the final follow-up (p > 0.05). The hardware failure rate in patients without osteoporosis was lower than that in patients with osteoporosis (14.3% vs. 57.1%) (p = 0.001). Conclusions Osteoporosis, fixation ending at C7, and low regional HU value of the screw trajectory were the independent risk factors of hardware failure after laminectomy and PCF. Future studies should illuminate if preventive measures targeting these factors can help reduce hardware failure and identified more risk factors, and perform long-term follow-up.

Purpose This study investigates the effects of hexagonal microtextured titanium sheets on fibroblast growth and collagen synthesis, crucial factors in anastomotic healing. Materials and methods Hexagonal titanium sheets were fabricated using a laser microtextured machine. Mouse fibroblastic embryonic stem cells (NIH/3T3) were cultured on these sheets. Cell proliferation was assessed using a CCK8 assay, and expression of TGF-β/Smad pathway-related genes and collagen types I and III was evaluated through qRT-PCR and western blot. Results Hexagonal titanium sheets significantly enhanced fibroblast growth and collagen synthesis. The 50–30 group, with the smallest contact angle (48 ± 2.3°), exhibited the highest cell growth rates by CCK8 assay. Gene expression analysis revealed that TGF-β1, Smad2, Smad3, Smad4, and COL1A1 were significantly upregulated in the 50–30 group on day 7. Meanwhile, type I collagen expression was significantly increased in the 50–30 group on day 7 by western blot analysis. Conclusion Our findings demonstrate that laser-fabricated hexagonal microtextured titanium sheets enhance hydrophilicity and promote fibroblast growth, activating the TGF-β/Smad pathway to facilitate collagen synthesis. These results have important implications for tissue repair and regeneration.

Background This retrospective study aimed to assess the suitability of POSSUM and its modified versions, E-PASS and its modified score, SRS, and SORT scores for predicting postoperative complications and mortality in patients undergoing laparoscopic radical gastrectomy for gastric cancer. Materials and methods Data analysis was performed on 349 patients who underwent laparoscopic radical gastrectomy at Tianjin Medical University General Hospital between January 2016 and December 2021. The discriminative ability of the scoring systems was evaluated using the area under the receiver operating characteristic curve (AUC). The primary endpoint focused on the prediction of postoperative complications, while the secondary endpoint assessed the prediction of postoperative mortality. Results Among the scoring systems evaluated, the modified E-PASS (mE-PASS) score exhibited the highest AUC (0.846) and demonstrated the highest sensitivity (81%) and specificity (79%) for predicting postoperative complications. All other scores, except for POSSUM, showed moderate discriminative ability in predicting complications. In terms of predicting postoperative mortality, the E-PASS score had the highest AUC (0.978), while the mE-PASS score displayed the highest sensitivity (76%) and specificity (90%). Notably, both E-PASS and mE-PASS scores exhibited excellent discriminative ability. Conclusions The P-POSSUM, O-POSSUM, E-PASS, mE-PASS, SRS, and SORT scoring systems are useful tools for predicting postoperative outcomes in laparoscopic radical gastrectomy. Among them, the mE-PASS score demonstrated the best predictive power. However, the POSSUM system could only be applicable to predict postoperative mortality.

Objective: The aim of this study was to assess associations of PART1 rs27565 and DEFB1 rs11362 polymorphisms with the prevalence of dental caries in twelve-year-old children in Nandan County, Guangxi, China. Methods: A total of 1,061 children were included in this cross-sectional study and divided into two groups based on the Decayed, Missing and Filled teeth (DMFT) index: caries-free children (DMFT score = 0) and children with caries (DMFT score ≥ 1). Demographic characteristics, oral hygiene behaviour and dietary habits were collected through household records and questionnaires. Genomic DNA was extracted from buccal cells, and PART1 rs27565 and DEFB1 rs11362 polymorphisms were genotyped using a custom-designed 48-Plex single nucleotide polymorphism-scan kit. Results: Carriers of the PART1 rs27565 C allele (odds ratio [OR] = 1.338, 95% confidence interval (CI) = 1.015–1.764, P value = 0.039) and carriers of the DEFB1 rs11362 T allele (OR = 1.364, 95% CI = 1.056–1.762, P value = 0.017) had a higher risk of caries. Carriers of the PART1 rs27565 TC or CC genotype who ate sugary food more than once a week had a 1.6-fold higher risk of caries than TT carriers who ate sugary food at most once a week (OR = 1.579, 95% CI = 1.032–2.414, P value = 0.035). Carriers of the DEFB1 rs11362 CT or TT genotype who ate sugary food more than once a week had a 2.1-fold higher risk of caries than CC carriers who ate sugary food at most once a week (OR = 2.057, 95% CI = 1.438–2.940, P value < 0.001). Conclusion: PART1 rs27565 and DEFB1 rs11362 polymorphisms were associated with caries in 12-year-old children in Nandan County, Guangxi, China. Carriers of the PART1 rs27565 TC or CC genotype and the DEFB1 rs11362 CT or TT genotype who ate sugary food more than once a week had a high probability of having caries.

Background To find out if three-dimensional printing (3DP) off-the-shelf (OTS) prosthesis is superior to titanium mesh cages in anterior cervical corpectomy and fusion (ACCF) when treating single-segment degenerative cervical spondylotic myelopathy (DCSM). Methods DCSM patients underwent ACCF from January 2016 to January 2019 in a single center were included. Patients were divided into the 3DP group (28) and the TMC group (23). The hospital stays, operation time, intraoperative blood loss, and the cost of hospitalization were compared. The Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) were recorded pre-operatively, 1 day, 3, 6, 12, and 24 months post-operatively. Radiological data was measured to evaluate fusion, subsidence, and cervical lordosis. Patients were sent with SF-36 to assess their health-related quality of life (HRQoL). Results The differences in operative time, intraoperative blood loss, and hospital stay were not statistically significant between groups ( p  > 0.05). Postoperative dysphagia occurred in 2 cases in the 3DP group and 3 cases in the TMC group, which all relieved one week later. The difference in improvement of JOA and NDI between the two groups was not statistically significant ( p  > 0.05). No hardware failure was found and bony fusion was achieved in all cases except one in the 3DP group. The difference in cervical lordosis (CL), fused segmental angle (FSA), mean vertebral height (MVH), and subsidence rates between groups at each follow-up time point was not statistically significant and the results of the SF-36 were similar ( p  > 0.05). The total cost was higher in the 3DP group with its higher graft cost ( p  < 0.05). Conclusion In treating single-segment DCSM with ACCF, both 3DP OTS prosthesis and TMC achieved satisfactory outcomes. However, the more costly 3DP OTS prosthesis was not able to reduce subsidence as it claimed.