Trauma is recognized globally as a great public health challenge. It stands as the predominant cause of mortality among those under the age of 45 and is also ranked among the top five causes of death for both urban and rural populations within China. This stark reality underscores the critical urgency in establishing an efficient system for trauma care, which is pivotal for substantially enhancing the survival rates of patients. An optimally developed system for trauma care not only guarantees that patients promptly receive professional medical assistance but also facilitates significant improvements in the outcomes of trauma care through the strategic establishment of trauma centers. At present, a considerable variation exists in the quality of trauma care provided across various regions within China. The adoption of comprehensive quality management strategies for the medical processes involved in trauma care, alongside the standardized management of on-site rescue operations, pre-hospital emergency care, and in-hospital treatment protocols, stands as a fundamental approach to boost the capabilities of trauma care and, consequently, the survival rates of trauma patients. Serving as the cornerstone of comprehensive medical quality management, key quality control indicators possess the capacity to steer the development direction of trauma centers. In a concerted effort to further augment the medical quality management of trauma care, standardize clinical diagnosis and treatment methodologies, and advocate for the standardization and ho-mogenization of medical services, the Medical Quality Control Professional Committee of the National Center for Trauma Medicine has undertaken a detailed refinement and update of the 16 key quality control indicators for trauma centers. These were initially put forward in the "Notice on Further Enhancing Trauma Care Capabilities" disseminated by the National Health Commission in 2018.Consequent to this endeavor, a revised set of 19 quality control indicators has been devised. This comprehensive set, inclusive of the indicators' names, definitions, calculation methodologies, significance, and the subjects for quality control, is designed for utilization within the quality management and control operations of trauma centers across various levels. This initiative aims to furnish a concrete and executable roadmap for the quality control endeavors of trauma centers. Through the enactment of these quality control indicators, medical institutions are empowered to conduct more stringent monitoring and evaluative measures across all facets of trauma care. This not only facilitates the prompt identification and rectification of existing challenges but also substantially boosts the efficiency of internal collaboration. It enhances the synergy between different departments, thereby markedly improving the efficiency and quality of trauma care.

Salivary gland tumor is one of the most common tumors in oral and maxillofacial regions. The diagnosis and treatment of salivary gland tumors had been a clinical characteristic project in Peking University School and Hospital of Stomatology since long time ago. Here we introduced the research progress in diagnosis and treatment of salivary gland tumors during the past 10 years. Among 7 190 cases of salivary gland tumors treated in this institution, 4 654 cases (64.7%) were benign, and 2 536 (35.3%) were malignant, with benign ∶ malignant ratio of 1.84 ∶ 1. Parotid was the most common location, followed by minor salivary gland and submandibular gland, while sublingular gland tumor was seldom seen. The proportion of minor salivary gland tumor was relatively high. Among 1 874 cases with primary malignant tumors, the cases with T3 and stage Ⅲ accounted for only 9.6% and 10.3%, respectively, which indicated that there was shortcoming in the T classification and clinical stage formulated by Union for International Cancer Control (UICC), and further revision was required. The 5, 10, and 15 year survival rates of 1 637 cases with postoperative follow-up were 93.1%, 87.2% and 79.3%, respectively, which were much higher than those we reported 30 years ago. The improvement of treatment results was related to more widely used combined treatment with surgery and postoperative radiotherapy, and the increase in patients with early stage. Adenoid cystic carcinoma was the malignant tumor with high rate of distant metastasis. The 5 and 10 year survival rates of the patients with pulmonary metastasis were 76.2% and 51.8%, respectively, which indicated that the pulmonary metastatic carcinomas developed slowly. Recurrent rate of carcinoma ex pleomorphic adenoma was 46.7% after single treatment of sur-gery, while it decreased to 27.5% after combined theraphy with surgery and radiotherapy, indicating that postoperative radiotheraphy could reduce the recurrent rate effectively. The normal myoepithelial cells had the inhibiting role in the invasion and metastasis of carcinoma ex pleomorphic adenoma. The evaluation of integrity of myoepithelial cells surrounding the tumor mass is helpful to understand the invasiveness of the tumors. The new surgical modalities such as extracapsular resection and partial sialoadenectomy were used in treatment of benign tumors of parotid gland and submandibular gland with advantages of decreased tissue damage and preservation of glandular function. Application of digital surgical techniques such as mixed reality combined with surgical navigation and real-time three-dimensional holograms in the surgical treatment of parotid gland tumors showed the benifits of more safety and precision, and less tissue da-mage.

Objective: To analyze the clinical data of histiocytic necrotizing lymphadenitis(HNL), comparing the similarities and differences between children and adults, to deepen the understanding of the disease by clinical physicians, and to improve diagnostic rate and reduce misdiagnosis and mistreatment. Methods: The clinical data of hospitalized patients with histiocytic necrotizing lymphadenitis diagnosed by biopsy from January 2010 to August 2023 in Peking University First Hospital were collec-ted, and the clinical features, laboratory examinations, pathological features, treatments with antibiotics and glucocorticoids, and prognosis of histiocytic necrotic lymphadenitis were analyzed. Grouped based on age, the differences of clinical characteristics, laboratory tests, treatment, and prognosis between the children group (< 16 years old) and the adult group (≥16 years old) were compared. Results: Among the 81 enrolled patients, there were 42 males and 39 females. The median age was 21(14, 29) years, the median duration of disease was 20.0(13.0, 30.0) days, and the median length of hospital stay was 13.0 (10.0, 15.0) days. The first symptoms were fever, lymphadenopathy, and both. All the patients had enlarged lymph nodes with different parts and sizes, 96.3% (78 of 81) of the patients had cervical lymphadenopathy, 50.6% (41 of 81) had bilateral cervical lymphadenopathy, 55.6% (45 of 81) had supraclavicular, axillary or inguinal lymphadenopathy, and the median lymph node diameter was 20.0(20.0, 30.0) mm. Only one patient had no fever, the other 80 patients had fever, the median peak body temperature was 39.0(38.0, 39.8) ℃. Accompanying symptoms: rash (8.6%, 7/81), fatigue (34.6%, 28/81), night sweating (8.6%, 7/81), chills (25.3%, 25/81), muscle soreness (13.6%, 11/81), and joint pain (6.2%, 5/81). There were 17 cases (21.0%, 17/81) of hepatosplenomegaly, of which 12 cases (70.6%, 12/17) were splenomegaly. 68.8%(55/80) of patients had a decrease in white blood cell (WBC) count, with 47.5%(38/80)increased in lymphocyte(LY)proportion, 53.4%(39/73) increased in high-sensitivity C-reactive protein(CRP), 79.2%(57/72) increased in erythrocyte sedimentation rate(ESR), 22.2%(18/81) increased in alanine transaminase(ALT), 27.2%(22/81) elevated in aspartate transaminase(AST), and 81.6%(62/76) elevated in lactate dehydrogenase(LDH). All the 81 patients underwent lymph node biopsy, and 77.8%(63/81) of the patients showed that most of the structures in the lymph nodes were destroyed or disappeared, and 16.0%(13/81) of the lymph nodes were still in existence, hyperplasia and normal lymph node were 1.2%(1/81) respectively, and 3.7%(3/81) had normal lymph node structures. Immunohistochemical staining was performed in 67 cases. The percentages of CD3⁺ and CD68(KP1)⁺ were respectively 97.0%(65/67), and MPO⁺ were 94.0%(63/67). In the study, 51 patients (63.0%, 51/81) were treated with glucocorticoid therapy after diagnosis. The median time for temperature to return to normal was 1.0(1.0, 4.0) days after glucocorticoid therapy. when the glucocorticoid treatment worked best, the body temperature could drop to normal on the same day. There were significant differences in length of stay, predisposing factors, chills, the rate of increase in high-sensitivity CRP, antibiotic and glucocorticoid treatment between the adults and children groups (P < 0.05). Conclusion: In clinical practice, if there are cases with unexplained fever, superficial lymph node enlargement, and reduced white blood cells as clinical characteristics, and general antibiotics treatment is ineffective, histiocytic necrotic lymphadenitis should be considered. Lymph node biopsy should be performed as early as possible to clarify the diagnosis, reduce misdiagnosis and mistreatment, and symptomatic treatment should be the main treatment. Glucocorticoids therapy has a definite therapeutic effect.

Objective: To establish a similarity measurement model for patients with dentofacial deformity based on 3D craniofacial features and to validate the similarity results with quantifying subjective expert scoring. Methods: In the study, 52 cases of patients with skeletal Class Ⅲ malocclusions who underwent bimaxillary surgery and preoperative orthodontic treatment at Peking University School and Hospital of Stomatology from January 2020 to December 2022, including 26 males and 26 females, were selected and divided into 2 groups by sex. One patient in each group was randomly selected as a reference sample, and the others were set as test samples. Three senior surgeons rated the similarity scores between the test samples and the reference sample. Similarity scores ranged from 1 to 10, where 1 was completely different, and 10 was exactly the same. Scores larger than 7.5 was considered as clinically similar. Preoperative cone beam computed tomography (CBCT) and 3D facial images of the patients were collected. The three-dimensional hard and soft tissue features, including distances, angles and 3D point cloud features were extracted. The similarity measurement model was then established to fit with the experts' similarity scoring by feature selection algorithm and linear regression model. To verify the reliability of the model, 14 new patients were selected and input to similarity measurement model for finding similar cases. The similarity scoring of these similar cases were rated by experts, and used to evaluate the reliability of the model. Results: The similarity metric models indicated that the features of the middle and lower craniofacial features were the main features to influence the craniofacial similarity. The main features that were related to the expert' s similarity scoring included distance of anterior nasal spine-menton (ANS-Me), distance of right upper canion point-Frankfurt horizontal plane (U3RH), distance of left superior point of the condyle-left gonion (CoL-GoL), distance of left gonion-menton (CoL-Me), distance of pogonion-midsagittal plane (Pog-MSP), distance of right alar base-left alar base (AlR-AlL), angle of pronasale-soft tissue pogonion-labrale inferius (Pn-Pog' -Li), distance of trichion-right tragus (Tri-TraR), distance of left exocanthion-left alar base (ExL-AlL), lower 1/3 of skeletal face, middle and lower 2/3 of skeletal face and upper lip region of soft tissue. Fourteen new patients were chosen to evaluate the model. The similar cases selected by the model had an average experts' similarity scoring of 7.627± 0.711, which was not significantly different with 7.5. Conclusion: The similarity measurement model established by this model could find the similar cases which highly matched experts' subjective similarity scoring. The study could be further used for similar cases retrieval in skeletal Ⅲ malocclusion patients.

Objective: To evaluate the health benefits and intervention efficiency of different strategies of initiating antihypertensive therapy for the primary prevention of cardiovascular diseases in a community-based Chinese population from the Chinese electronic health records research in Yinzhou (CHERRY) study. Methods: A decision-analytic Markov model was used to simulate and compare different antihypertensive initiation strategies, including: Strategy 1, initiation of antihypertensive therapy for Chinese adults with systolic blood pressure (SBP) ≥140 mmHg (2020 Chinese guideline on the primary prevention of cardiovascular diseases); Strategy 2, initiation of antihypertensive therapy for Chinese adults with SBP ≥130 mmHg; Strategy 3, initiation of antihypertensive therapy for Chinese adults with SBP≥140 mmHg, or with SBP between 130 and 140 mmHg and at high risk of cardiovascular diseases (2017 American College of Cardiology/American Heart Association guideline for the prevention, detection, evaluation, and management of high blood pressure in adults); Strategy 4, initiation of antihypertensive therapy for Chinese adults with SBP≥160 mmHg, or with SBP between 140 and 160 mmHg and at high risk of cardiovascular diseases (2019 United Kingdom National Institute for Health and Care Excellence guideline for the hypertension in adults: Diagnosis and management). The high 10-year cardiovascular risk was defined as the predicted risk over 10% based on the 2019 World Health Organization cardiovascular disease risk charts. Different strategies were simulated by the Markov model for ten years (cycles), with parameters mainly from the CHERRY study or published literature. After ten cycles of simulation, the numbers of quality-adjusted life years (QALY), cardiovascular events and all-cause deaths were calculated to evaluate the health benefits of each strategy, and the numbers needed to treat (NNT) for each cardiovascular event or all-cause death could be prevented were calculated to assess the intervention efficiency. One-way sensitivity analysis on the uncertainty of incidence rates of cardiovascular disease and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted. Results: A total of 213 987 Chinese adults aged 35-79 years without cardiovascular diseases were included. Compared with strategy 1, the number of cardiovascular events that could be prevented in strategy 2 increased by 666 (95% UI: 334-975), while the NNT per cardiovascular event prevented increased by 10 (95% UI: 7-20). In contrast to strategy 1, the number of cardiovascular events that could be prevented in strategy 3 increased by 388 (95% UI: 194-569), and the NNT per cardiovascular event prevented decreased by 6 (95% UI: 4-12), suggesting that strategy 3 had better health benefits and intervention efficiency. Compared to strategy 1, although the number of cardiovascular events that could be prevented decreased by 193 (95% UI: 98-281) in strategy 4, the NNT per cardiovascular event prevented decreased by 18 (95% UI: 13-37) with better efficiency. The results were consistent in the sensitivity analyses. Conclusion: When initiating antihypertensive therapy in an economically developed area of China, the strategy combined with cardiovascular risk assessment is more efficient than those purely based on the SBP threshold. The cardiovascular risk assessment strategy with different SBP thresholds is suggested to balance health benefits and intervention efficiency in diverse populations.

Objective: To analyze RELT gene mutation found in a pedigree with clinical features and inheritable pattern consistent with amelogenesis imperfecta (AI) in China, and to study the relationship between its genotype and phenotype. Methods: Clinical and radiological features were recorded for the affected individuals. Peripheral venous blood samples of the patient and family members were collected for further study, and the genomic DNA was extracted to identify the pathogenic gene. Whole exome sequencing (WES) was performed to analyze the possible pathogenic genes, and Sanger sequencing was performed for validation. SIFT and PolyPhen-2 were used to predict and analyze the mutation effect. Comparison of RELT amino acids across different species were performed by using Uniprot website. In addition, the three-dimen-sional structures of the wild type and mutant proteins were predicted by Alphafold 2. Results: The proband exhibited typical hypocalcified AI, with heavy wear, soft enamel, rough and discolored surface, and partial enamel loss, while his parents didn ' t have similar manifestations. WES and Sanger sequencing results indicated that the proband carries a homozygous frameshift mutation in RELT gene, NM_032871.3: c.1169_1170del, and both of his parents were carriers. This mutation was predicted to be pathogenic by SIFT and PolyPhen-2. Up to now, there were 11 mutation sites in RELT gene were reported to be associated with AI, and all of the patients exhibited with hypocalcified AI. Compared with the wild-type RELT protein, the mutant protein p. Pro390fs35 conformation terminated prematurely, affecting the normal function of the protein. Conclusion: Through phenotype analysis, gene sequencing, and functional prediction of a Chinese family with typical amelogenesis imperfecta, this study found that RELT gene frameshift mutation can lead to protein dysfunction in AI patients. Further research will focus on the role and mechanism of RELT in enamel development at the molecular and animal levels, providing molecular biology evidence for the genetic counseling, prenatal diagnosis, and early prevention and treatment of AI.

Objective: To assess the safety of sitagliptin added to metformin on cardiovascular adverse events in real world patients with type 2 diabetes mellitus (T2DM). Methods: Real world data from Yinzhou Regional Health Care Database were used to select T2DM patients with diagnosis and treatment records in the platform from January 1, 2017 to December 31, 2022. According to drug prescription records, the patients were divided into metformin plus sitagliptin group (combination group) and metformin monotherapy group(monotherapy group). A series of retrospective cohorts were constructed according to the index date.Finally, full retrospective cohorts were constructed according to propensity score model, including baseline covariates that might be related to outcomes, to match the subjects in the combination group and monotherapy group for the purpose of increasing the comparability of baseline characteristics. The participants were followed up from the index date until the first occurrence of the following events: Diagnosis of outcomes, death, or the end of the study period (December 31, 2022). Cox proportional risk model was used to estimate the hazard ratio(HR)and 95% confidence interval (CI) of sitagliptin added to metformin on 3-point major adverse cardiovascular events (3P-MACE) combination outcome and secondary cardiovascular outcomes. Results: Before propensity score matching, the proportion of the patients in combination group using insulin, α glucosidase inhibitors, sodium-glucose transporter 2 inhibitors (SGLT-2I) and glienides at baseline was higher than that in monotherapy group, and the baseline fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels in combination group were higher than those in monotherapy group. After propensity score matching, 5 416 subjects were included in the combination group and the monotherapy group, and baseline characteristics were effectively balanced between the groups. The incidence densities of 3P-MACE were 6.41/100 person years and 6.35/100 person years, respectively. Sitagliptin added to metformin did not increase or decrease the risk of 3P-MACE compared with the metformin monotherapy (HR=1.00, 95% CI: 0.91-1.10). In secondary outcomes analysis, the incidence of cardiovascular death was lower in the combination group than in the monotherapy group (HR=0.59, 95% CI: 0.41-0.85), and no association was found between sitagliptin and the risk of myocardial infarction and stroke (HR=1.12, 95% CI: 0.89-1.41; HR=0.99, 95% CI: 0.91-1.12). Conclusion: In T2DM patients in Yinzhou district of Ningbo, compared with metformin alone, sitagliptin added to metformin may reduce the risk of cardiovascular death, and do not increase the incidence of overall cardiovascular events. The results of this study can provide real-world evidence for post-marketing cardiovascular safety evaluation of sitagliptin.

In December 2023, the Trauma Professional Committee of the American Society of Surgeons officially released the seventh edition of "Resources for Optimal Care of the Injured Patient (2022 Stan-dards)". Compared to the sixth edition of the standards, the main updated content of the seventh edition includes ten aspects: (1) trauma centers need to meet new personnel configuration and qualification requirements, (2) trauma centers need to develop more structured and effective trauma treatment effectiveness improvement and patient safety plans, (3) trauma centers need to develop data quality plans, (4) trauma centers need to develop new diagnosis and treatment plans for specific patients, (5) trauma centers need to have new professional knowledge, (6) trauma centers need to meet new response time and resource availability standards, (7) trauma centers need to meet new academic and scientific requirements, (8) tertiary trauma centers need corresponding qualification certificates if providing neurological trauma treatment, (9) new requirements for pediatric trauma centers, (10) the fourth level trauma center standards. The research literature published by scholars in the field of trauma in the past decade has provided sufficient evidence-based medicine evidence for updating content. The article introduces and analyzes the updates in the seventh edition standards in light of the available evidence.

Objective: To study the durability of the anti-demineralization effects of fluoride varnish after being applied to dental root surfaces. Methods: Coronal and radicular dentin samples were prepared from extracted human teeth. Duraphat^® (DP) was applied to the dentine surfaces to form a protective film. The film-dentin interfaces were observed by scanning electron microscopy (SEM) and the fluoride element was analyzed with energy dispersive spectrometer (EDS). Thus, the differences between applying DP on crowns and roots were compared. Radicular dentin samples were prepared and randomly divi-ded into four groups: (1) Blank: DP was not applied, and demineralized in acetic acid (pH 4.5) for 4 days; (2) Blank+aging: DP was not applied, the samples were put into deionized water for 14 days at room temperature, and then demineralized in acetic acid (pH 4.5) for 4 days; (3) DP: DP was applied and demineralized in acetic acid (pH 4.5) for 4 days; (4) DP+aging: DP was applied, the samples were put into deionized water for 14 days at room temperature, and then demineralized in acetic acid (pH 4.5) for 4 days. Finally, SEM observation and EDS analysis of fluoride content were performed on film-dentin interfaces to evaluate the degree of demineralization, the morphology of DP film, and the penetration of fluorine. Results: The immediate penetration depth of fluoride element from DP was deeper in the coronal dentin than that in radicular dentin. The samples in the blank and blank+aging groups demine-ralized significantly after acid etching. The DP group did not undergo demineralization, and the fluorine element penetrated to (76.00±8.94) μm below the interfaces. The structure of the protective film in the DP+aging group was damaged, but the underneath dentin did not undergo demineralization. The fluorine element still remained at a depth of (5.00±3.53) μm below the interfaces. Conclusion: DP has an anti-demineralization effect on the root surface, and this effect can still be exerted for a period of time after losing the structure of protective film. It has the ability to prevent root caries and a certain durability.

Objective: To assess the rationality of the maximum lesion diameter of 15 mm in prostate imaging reporting and data system (PI-RADS) as a criterion for upgrading a lesion from category 4 to 5 and improve it to enhance the prediction of clinically significant prostate cancer (csPCa). Methods: In this study, the patients who underwent prostate magnetic resonance imaging (MRI) and prostate biopsy at Peking University First Hospital from 2019 to 2022 as a development cohort, and the patients in 2023 as a validation cohort were reviewed. The localization and maximum diameter of the lesion were fully evaluated. The area under the curve (AUC) and the cut-off value of the maximum diameter of the lesion to predict the detection of csPCa were calculated from the receiver operating characteristics (ROC) curve. Confounding factors were reduced by propensity score matching (PSM). Diagnostic efficacy was compared in the validation cohort. Results: Of the 589 patients in the development cohort, 358 (60.8%) lesions were located in the peripheral zone and 231 (39.2%) were located in the transition zone, and 496 (84.2%) patients detected csPCa. The median diameter of the lesions in the peripheral zone was smaller than that in the transition zone (14 mm vs. 19 mm, P < 0.001). In the ROC analysis of the maximal diameter on the csPCa prediction, there was no statistically significant difference between the peri-pheral zone (AUC=0.709) and the transition zone (AUC=0.673, P=0.585), and the cut-off values were calculated to be 11.5 mm for the peripheral zone and 16.5 mm for the migrating zone. By calcula-ting the Youden index for the cut-off values in the validation cohort, we found that the categorisation by lesion location led to better predictive results. Finally, the net reclassification index (NRI) was 0.170. Conclusion: 15 mm as a criterion for upgrading the PI-RADS score from 4 to 5 is reasonable but too general. The cut-off value for peripheral zone lesions is smaller than that in transitional zone. In the future consideration could be given to setting separate cut-off values for lesions in different locations.

Objective: To evaluate the clinical efficacy of clear aligner therapy in patients with severe periodontitis accompanied by pathological tooth displacement in the anterior region. Methods: This retrospective study analyzed patients diagnosed with severe periodontitis and pathological displacement in the anterior region, who visited both the Periodontics and Orthodontics Departments at Peking University School and Hospital of Stomatology between 2019 and 2022. A total of 26 eligible cases were included in this study. All the patients underwent regular periodontal maintenance throughout the treatment process, and clear aligners were used for orthodontic treatment. Intraoral scans were analyzed by dedicated software to measure and compare occlusal distribution and proximal contact scores before and after orthodontic treatment. Periodontal clinical indicators were assessed at three key time points: before periodontal treatment (T0), before orthodontic treatment (T1), and after orthodontic treatment (T2). All the cases were treated with clear aligner. Results: A total of 217 pathologically displaced anterior teeth from 26 patients were analyzed. Among these, 105 teeth exhibited periodontal pockets [probing depth (PD) ≥5 mm] before periodontal treatment. After clear aligner therapy, the occlusal score improved significantly from 10.35±8.61 to 23.62±9.73 (P < 0.001), and the proximal contact score increased from 13.62±4.73 to 31.62±10.37 (P < 0.001). The median PD decreased significantly from 3.33 mm [interquartile range (IQR)=0.92] at T0 to 2.50 mm (IQR=0.67, P < 0.001) at T1 and remained stable at 2.50 mm (IQR=0.50) after treatment (T2). A significant reduction in PD was observed between T0 and T2 (P < 0.001), but no significant difference was found between T1 and T2 (P=0.948). Conclusion: Clear aligner therapy demonstrates favorable clinical efficacy in patients with severe periodontitis and pathological anterior tooth displacement. It effectively improves occlusal distribution and proximal contact while maintaining periodontal health in these patients. However, further large-scale prospective controlled studies are needed to verify its long-term clinical outcomes.

Objective: To explore the function of LIM and calponin homology domains 1 (LIMCH1) in the development and progression of oral squamous cell carcinoma (OSCC), along with their potential clinical applications. Methods: By utilizing transcriptome sequencing data from two groups of oral squamous cell carcinoma patients, along with bioinformatics analytical techniques such as Gene Ontology (GO) and gene co-expression networks, we identified genes that might play a pivotal role in the pathogenesis of oral squamous cell carcinoma. We employed real-time quantitative PCR and Western blotting to validate the expression patterns of these genes across twelve patient tissue samples. Furthermore, we conducted CCK-8 assays, flow cytometry analyses, and scratch wound healing assays to assess the impact of key genes on the biological behaviors of both the Cal27 oral squamous cell carcinoma cell line and the potentially malignant DOK oral lesion cell line. Additionally, we examined correlations between these key genes and clinical disease parameters in 214 oral squamous cell carcinoma patients using The Cancer Genome Atlas (TCGA) data; gene set enrichment analysis (GSEA) analysis results were also incorporated to enhance our findings from real-time quantitative PCR and Western blotting regarding potential mechanisms underlying the action of these key genes. Results: The integrated analysis of sequencing data and bioinformatics revealed that LIMCH1 exhibited significantly reduced mRNA (P < 0.001) and protein levels (P < 0.01) in the oral squamous cell carcinoma tissues compared with normal control tissues. In the Cal27 cells, the low LIMCH1 level group demonstrated a larger wound healing area within 24 hours than the control group (P < 0.01), enhanced proliferation capacity over 72 hours relative to the control group (P < 0.01), and an increased apoptosis rate within 24 hours compared with the high expression group (P < 0.05). However, no significant differences were observed between the low and high level groups in DOK cells. Furthermore, it was determined that low LIMCH1 level correlated with poor prognosis in the patients (P=0.013) and a higher lymph node metastasis rate (P < 0.05). Investigations into the potential mechanisms of action indicated that LIMCH1 did not influence the onset or progression of oral squamous cell carcinoma via the epithelial-mesenchymal transition pathway. Conclusion: LIMCH1 level may function as a promising biomarker to aid in the prognostic assessment of oral squamous cell carcinoma; however, its precise mechanistic role requires further investigation.

Objective: To investigate the effects of LncRNA SNHG20 on epithelial mesenchymal transition (EMT) and microtubule formation in human oral squamous cell carcinoma (OSCC) cells through targeted regulation of the miR-520c-3p/RAB22A pathway. Methods: After real-time fluorescence quantitative detection of LncRNA SNHG20, miR-520c-3p, RAB22A mRNA expression levels in OSCC tissues and cells, dual luciferase reporter assay was used to detect the relationship between the three. OSCC cells were randomly separated into control group, sh-NC group, sh-SNHG20 group, sh-SNHG20+anti NC group, and sh-SNHG20+anti miR-520c-3p group. Western blotting was used to detect the expression of N-cadherin, vimentin, and E-cadherin proteins in the OSCC cells. The morphology of HSC-3 cells was observed under microscope. Changes in the number of microtubules formed were detected. The effect of LncRNA SNHG20 on the growth of OSCC tumors and the expression levels of LncRNA SNHG20, miR-520c-3p and RAB22 A in the transplanted tumors were detected by nude mice tumorigenesis experiment. Results: LncRNA SNHG20 and RAB22A mRNA were upregulated in the OSCC tissues and cells, while miR-520c-3p was downregulated (P < 0.05). There were binding sites between LncRNA SNHG20 and miR-520c-3p, RAB22A and miR-520c-3p, which had targeted regulation relationship. Compared with the sh-NC group, the sh-SNHG20 group had fewer stromal like cells, more epithelial like cells, incomplete microtubule structure, and fewer nodules. LncRNA SNHG20, RAB22A, N-Cadherin, and vimentin were downregulated, while miR-520c-3p and E-cadherin were upregulated (P < 0.05). Compared with the sh-SNHG20+anti-NC group, the sh-SNHG20+anti-miR-520c-3p group had a higher number of stromal like cells, a lower number of epithelioid cells, tighter microtubule arrangement, and more microtubule nodules. miR-520c-3p and E-cadherin were downregulated, while RAB22A, N-cadherin, and vimentin were upregulated (P < 0.05). The transplanted tumor of OSCC in sh-SNHG20 group was smaller and lower than that in sh-NC group. The expression levels of LncRNA SNHG20 and RAB22A in the transplanted tumor tissues were lower than those in sh-NC group, and the expression level of miR-520c-3p was higher than that in sh-NC group (P < 0.05). Conclusion: LncRNA SNHG20 promotes epithelial-mesenchymal transition and microtubule formation in human oral squamous cell carcinoma cells by targeting the miR-520c-3p/RAB22A pathway. Inhibiting the expression of LncRNA SNHG20 can target and regulate the miR-520c-3p/RAB22A pathway to inhibit EMT and microtubule formation in OSCC cells.

Objective: To quantitatively evaluate the accuracy of data obtained from liquid-interference surfaces using an intraoral 3D scanner (IOS) integrated with a compressed airflow system, so as to provide clinical proof of accuracy for the application of the compressed airflow system-based scanning head in improving data quality on liquid-interference surfaces. Methods: The study selected a standard model as the scanning object, adhering to the "YY/T 1818—2022 Dental Science Intraoral Digital Impression Scanner" guidelines, a standard that defined parameters for intraoral scanning. To establish a baseline for accuracy, the ATOS Q 12M scanner, known for its high precision, was used to generate true reference values. These true values served as the benchmark for evaluating the IOS performance. Building on the design of an existing scanner, a new scanning head was developed to integrate with a compressed airflow system. This new design aimed to help the IOS capture high-precision data on surfaces where liquid-interference, such as saliva, might otherwise degrade scanning accuracy. The traditional scanning method, without airflow assistance, was employed as a control group for comparison. The study included five groups in total, one control group and four experimental groups, to investigate the effects of scanning lens obstruction, airflow presence, liquid media, and the use of the new scanning head on scanning process and accuracy. Each group underwent 15 scans, generating ample data for a robust statistical comparison. By evaluating trueness and precision in each group, the study assessed the impact of the compressed airflow system on the accuracy of IOS data collected from liquid-interference surfaces. Additionally, we selected Elite and Primescan scanners as references for numerical accuracy values. Results: The scanning accuracy on liquid-interference surfaces was significantly reduced in terms of both trueness and precision [Trueness: 18.5 (6.5) vs. 38.0 (6.7), P < 0.05; Precision: 19.1 (8.5) vs. 31.7 (15.0), P < 0.05]. The use of the new scanning head assisted by the compressed airflow system significantly improved the scanning accuracy [Trueness: 22.3(7.6) vs. 38.0 (6.7), P < 0.05; Precision: 25.8 (9.6) vs. 31.7 (15.0), P < 0.05]. Conclusion: The scanning head based on the compressed airflow system can assist in improving the accuracy of data obtained from liquid-interference surfaces by the IOS.

Objective: To compare the cyclic fatigue resistance of nickel-titanium files made by 3 new heat treatment in simulated S-shaped root canals at different temperatures. Methods: Gold heat-treated nickel-titanium files TruNatomy (25 mm, tip size 26#/0.04) and ProTaper Gold (25 mm, tip size 25#/0.08) were selected as the experimental group, M wire technique nickel-titanium file ProTaper Next (25 mm, tip size 25#/0.06) was selected as the control group. It was speculated that the Gold technique used in TruNatomy nickel-titanium file was R phase separation technique, which included a complete intermediate R-phase, increasing its flexibility. ProTaper Gold was a CM wire nickel-titanium file and the increased phase transformation temperature by heat treatment introduced martensite at room temperature, while it underwent gold heat treatment on the surface, generating an intermediate R phase during phase transformation, providing hyperelastic. ProTaper Next used M wire technique, M wire included austenite at room temperature, where heat mechanical processing introduced hardened martensite, which was incapable of participating phase transformation. Because of the lower elastic modulus of hardened martensite than austenite, the flexibility of the file was increased. Twenty instruments of each nickel-titanium file were submitted to the cyclic fatigue test by using a simulated canal with double curvatures at room tem-perature (24 ℃) and 65 ℃, 10 instruments of each nickel-titanium file were selected at each temperature (n=10). At the same temperature, the number of cyclic fatigue (NCF) and fragment length were analyzed by using One-Way analysis of variance at a significance level of P < 0.05. NCF and fragment length of the same nickel-titanium file at room temperature and 65 ℃ were compared by paired sample t test and the significance level was α=0.05. Fractured surfaces were analyzed by using scanning electron microscope. Results: In double-curved canals, all the failure of the files due to cyclic fatigue was first seen in the apical curvature before the coronal curvature. At room temperature, in the apical curvature, NCF of TruNatomy was 344.4±96.6, ProTaper Gold was 175.0±56.1, ProTaper Next was 133.3±39.7, NCF of Tru Natomy was the highest (P < 0.05). In the coronal curvature, NCF of TruNatomy was 618.3± 75.3, ProTaper Gold was 327.5±111.8, ProTaper Next was 376.6±67.9, NCF of TruNatomy was also the highest (P < 0.05). There was no significant difference among the apical and coronal fragment length of the 3 nickel-titanium files (P>0.05). At 65 ℃, in the apical curvature, NCF of TruNatomy was 289.6±65.8, ProTaper Gold was 187.5±75.4, ProTaper Next was 103.0±38.5, NCF of TruNatomy was the highest (P < 0.05). In the coronal curvature, NCF of TruNatomy was 454.2±45.4, ProTaper Gold was 268.3±31.4, ProTaper Next was 283.8±31.7, NCF of TruNatomy was also the highest (P < 0.05). The apical fragment length of ProTaper Next was the highest (P < 0.05), and there was no significant difference among coronal fragment length of the 3 nickel-titanium files (P>0.05). Compared with room temperature, at 65 ℃, in the coronal curvature, NCF of TruNatomy decreased significantly (P < 0.05). The fractured surfaces of the three nickel-titanium files demonstrated typical cyclic fatigue. Conclusion: Gold heat-treated nickel-titanium file had better cyclic fatigue resistance than M wire nickel-titanium file in S-shaped root canals.

Objective: To evaluate the clinical and radiographic efficacy of micro crestal flap-alveolar ridge preservation following extraction of mandibular molars with severe periodontitis compared with natural healing, and to preliminarily propose the surgical indication. Methods: A retrospective analysis was conducted on clinical data from patients with mandibular molars with severe periodontitis either receiving micro crestal flap-alveolar ridge preservation (MCF-ARP group) or undergoing natural healing in department of periodontology, Peking University School and Hospital of Stomatology from September 2013 to June 2021. Cone-beam computed tomography scannings performed before/immediately after extraction (as baseline) and repeated before implantation (after the extraction socket healing) were used to measure the ridge width, height and volumetric changes of the sockets, and the proportion of guided bone regeneration (GBR) during implant therapy were compared between the two groups. Results: Between baseline and healing, significant differences in changes of MCF-ARP group [(8.34±2.81) mm] and natural healing group [(3.82±3.58) mm] in the distances from mandibular canal to center of the tooth socket were recorded (P < 0.001). The ridge width at 1 mm below the most coronal aspect of the crest increased by (3.50±4.88) mm in the MCF-ARP group but decreased by (0.16±5.70) mm in the natural healing group, respectively (P=0.019). After healing, the MCF-ARP group showed the distances from mandibular canal to center of the tooth socket >8 mm in all the cases, with 97.1% exceeding 10 mm. Natural healing group displayed 23.1% of the cases with center bone height < 8 mm and 61.5% exceeding 10 mm. Volume changes at the buccal and lingual aspect as well as the total socket were significantly greater in the MCF-ARP group compared with natural healing group (P < 0.001).At the time of implantation, GBR was performed in 5 out of 68 subjects (8.3%) in the MCF-ARP group, whereas 8 out of 26 subjects (30.8%) in the natural healing group required GBR, reflecting significant difference (P=0.003). Conclusion: In the sites of mandibular molars with severe periodontitis, when the distances from mandibular canal to center of the tooth socket was not enough (less than 7 mm), clinicians could consider performing the micro crestal flap-alveolar ridge preservation to achieve augmentation for alveolar ridge and reduce the proportion of guided bone regeneration during implant therapy to reduce the difficulty and risk of injuries during implant therapy.

Objective: To initially investigate the function of neuronal pentraxin 1 (NPTX1) gene on osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs). Methods: hBMSCs were induced to undergo osteogenic differentiation, and then RNA was collected at different time points, namely 0, 3, 7, 10 and 14 d. The mRNA expression levels of key genes related with osteogenic differentiation, including runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteocalcin (OCN), and NPTX1, were detected on the basis of quantitative real-time polymerase chain reaction (qPCR) technology. In order to establish a stable NPTX1-knockdown hBMSCs cell line, NPTX1 shRNA lentivirus was constructed and used to infect hBMSCs. ALP staining, alizarin red (AR) staining, and qPCR were employed to assess the impact of NPTX1-knockdown on the osteogenic differentiation ability of hBMSCs. Results: The results showed that during the osteogenic differentiation of hBMSCs in vitro, the mRNA expression levels of osteogenic genes RUNX2, ALP and OCN significantly increased compared with 0 d, while NPTX1 expression decreased markedly (P < 0.01) as the osteogenic induction period exten-ded. At 72 h post-infection with lentivirus, the result of qPCR indicated that the knockdown efficiency of NPTX1 was over 60%. After knocking down NPTX1 in hBMSCs, RNA was extracted from both the NPTX1-knockdown group (sh NPTX1 group) and the control group (shNC group) cultured in regular proliferation medium. The results of qPCR showed that the expression levels of osteogenic-related genes RUNX2 and osterix (OSX) were significantly higher in the sh NPTX1 group compared with the shNC group (P < 0.01). ALP staining revealed a significantly deeper coloration in the sh NPTX1 group than in the shNC group at the end of 7 d of osteogenic induction. AR staining demonstrated a marked increase in mineralized nodules in the sh NPTX1 group compared with the shNC group at the end of 14 d of osteogenic induction. Conclusion: NPTX1 exerts a modulatory role in the osteogenic differentiation of hBMSCs, and its knockdown has been found to enhance the osteogenic differentiation of hBMSCs. This finding implies that NPTX1 could potentially serve as a therapeutic target for the treatment of osteogenic abnormalities, including osteoporosis.

Objective: To explore the relationship between lipid metabolism molecules in plasma and carotid atherosclerotic plaques, traditional cardiovascular risk factors and possible dietary related factors. Methods: Firstly, among 1 312 community people from those who participated in a 10-year follow-up study of subclinical atherosclerosis cohort in Shijingshan District, Beijing, 85 individuals with 2 or more carotid soft plaques or mixed plaques and 89 healthy individuals without plaques were selected according to the inclusive and the exclusive criteria (< 70 years, not having clinical cardiovascular disease and other diseases, etc.). Secondly, 10 cases and 10 controls were randomly selected in the above 85 and 89 individuals respectively. Carotid plaques were detected using GE Vivid i Ultrasound Machine with 8L detector. Lipid metabolism molecules were detected by high performance liquid chromatography-mass spectrometry. The detection indexes included 113 lipid metabolism molecules. Traditional cardiovascular risk factors were collected by unified standard questionnaires, and dietary related factors were collected by main dietary frequency and weight scale. The difference of lipid metabolism molecules between the case group and the control group was analyzed by Wilcoxin rank test. In the control group, the Spearman correlation method was used to analyze the correlation between statistically significant lipid metabolism molecules and traditional cardiovascular risk factors and dietary factors. Results: Among the 113 lipid metabolism molecules, 53 lipid metabolism molecules were detected. C24:0 sphingomyelin (SM), C22:0/ C24:0 ceramide molecules, C18:0 phosphoethanolamine (PE) molecules, and C18:0/C18:2 (Cis) phosphatidylcholine (PC) were significantly higher in the carotid atherosclerotic plaque group than in the control group. The correlation analysis showed that C24:0 SM was significantly positively correlated with low density lipoprotein cholesterol (LDL-C, r=0.636, P < 0.05), C18:2 (Cis) PC (DLPC) was significantly positively correlated with systolic pressure (r=0.733, P < 0.05), C18:0 PE was significantly positively correlated with high sensitivity C-response protein (r=0.782, P < 0.01), C22:0, C24:0 ceramide and C18:0 PE were negatively correlated with vegetable intake (r=-0.679, P < 0.05;r=-0.711, P < 0.05;r=-0.808, P < 0.01), C24:0 ceramide was also negatively correlated with beans food intake (r=-0.736, P < 0.05) in the control group. Conclusions: The increase of plasma C24:0 SM, C22:0, C24:0 ceramide, C18:0 PE, C18:2 (Cis) PC (DLPC), C18:0 PC (DSPC) may be new risk factors for human atherosclerotic plaques. These molecules may be related to blood lipid, blood pressure or inflammatory level and the intake of vegetables and soy products, but the nature of the association needs to be verified in a larger sample population.

Adolescence is defined as a population ranging from ten to nineteen years old. Permanent teeth in adolescents are of critical significance as they are actively involved in mastication, contribute to aesthetic appearance, play a role in pronunciation, and are integral to the growth and development of the stomatognathic system. Specifically, permanent teeth in adolescents comprise those with incomplete root development and those with complete root development but unstable gingival margin positions. However, the prevalence of permanent tooth defects among adolescents remains high, primarily due to their insufficient awareness of oral health care and poor compliance with preventive measures. Therefore, it is very important to emphasize the necessity for timely and appropriate restoration of permanent tooth defects in adolescents. Given the distinct physiological characteristics of adolescent permanent teeth compared with mature permanent teeth, interim restoration approaches are required. The field of adolescent permanent tooth restoration is an interdisciplinary area, involving both prosthodontics and pediatric dentistry. Currently, a comprehensive and standardized principle for the selection of restoration indications is lacking, which poses challenges for clinicians in making optimal treatment decisions. Therefore, this article aims to comprehensively summarize the clinical dilemmas associated with the restoration of adolescent permanent teeth, and propose a set of principles for the selection of restoration methods and materials, aiming to offer practical clinical guidelines for dentists when dealing with permanent tooth defects in adolescent patients. In particular, because of the different restoration dilemmas of anterior and posterior permanent teeth, a variety of interim restoration methods, their applicable conditions, advantages, and disadvantages are introduced respectively. Additionally, it provides an in-depth discussion of different interim restoration materials, including direct restoration materials like light-cured composite resin and dual-cured temporary crown resin, as well as indirect restoration materials such as polymeric porcelain and CAD/CAM resin-matrix ceramics. The goal of this research is to provide a foundation for the development of evidence-based restoration plans in clinical practice and to contribute to the establishment of future standards in the field of adolescent permanent tooth restoration. This will enhance the quality of dental care for adolescents and promote better oral health outcomes in this population.

Objective: To evaluate knee biomechanics of patients about 12 months after anterior cruciate ligament (ACL) reconstruction during cutting and determine the abnormal biomechanical characteristics. Methods: Sixteen males about 12 months after ACL reconstruction were recruited for this study. Three-dimensional kinematic and kinetic data were collected during cutting movement. Knee joint angles and moments were calculated. Paired t-tests were used to compare the differences in knee biomechanics between the surgical leg and nonsurgical leg. Results: The peak posterior ground reaction force (surgical leg: 0.380±0.071; nonsurgical leg: 0.427±0.069, P = 0.003) and vertical ground reaction force (surgical leg: 1.996±0.202, nonsurgical leg: 2.110±0.182, P = 0.001) were significantly smaller in the surgical leg than in the nonsurgical leg. When compared with the uninjured leg, the surgical leg demonstrated a smaller knee flexion angle (surgical leg: 38.3°± 7.4°; nonsurgical leg: 42.8°± 7.9°, P < 0.001) and larger external rotation angle (surgical leg: 10.3°± 2.4°; nonsurgical leg: 7.7°± 2.1°, P = 0.008). The surgical leg also demonstrated a smaller peak knee extension moment (surgical leg: 0.092 ± 0.031; nonsurgical leg: 0.133 ± 0.024, P < 0.001) and peak knee external rotation moment (surgical leg: 0.005 ± 0.004; nonsurgical leg: 0.008 ± 0.004, P = 0.015) when compared with the nonsurgical leg. Conclusion: The individuals with ACL reconstruction mainly showed asymmetrical movements in the sagittal and horizontal planes. The surgical leg demonstrated a smaller peak knee flexion angle, knee extension moment, and knee external rotation moment, with greater knee external rotation angle.

Objective: To investigate the expression and physiological significance of the ferroptosis marker 4-hydroxynonenal (4-HNE) in myofibroblasts induced by transforming growth factor-β1 (TGF-β1), providing theoretical evidence for its potential role in the diagnosis and treatment of fibrosis in systemic sclerosis (SSc). Methods: Mouse embryonic fibroblasts (NIH3t3) were cultured and divided into two groups after 12 h of starvation: the control group (cultured in 1% serum-containing medium) and the TGF-β1 group (cultured in 10 μg/L TGF-β1 with 1% serum-containing medium). Cell morphology changes in both groups were observed under a microscope. To confirm successful establishment of the SSc cell model, fibrosis markers were analyzed using reverse transcription quantitative real-time PCR (RT-qPCR) and Western blot. Next, flow cytometry was employed to assess the intracellular levels of reactive oxygen species (ROS) in both groups. Finally, Western blot and immunofluorescence staining were used to measure the expression of 4-HNE in the TGF-β1-treated cells. Results: Microscopic observations revealed that TGF-β1 treatment caused the NIH3t3 cells to transition from a typical spindle shape to a flat, polygonal shape with multiple protrusions, indicating fibroblast activation. The RT-qPCR and Western blot analyses showed that the expression of the fibrosis marker Vimentin was significantly upregulated in the TGF-β1 group compared with the control group (P < 0.01), confirming that TGF-β1 effectively promoted fibrosis-related gene and protein expression. Flow cytometry results indicated that TGF-β1 significantly elevated intracellular ROS levels, suggesting the induction of oxidative stress. Furthermore, both Western blot and immuno-fluorescence staining demonstrated a significant increase in 4-HNE expression in the TGF-β1-treated cells (immunofluorescence intensity P < 0.05). Conclusion: TGF-β1 promotes fibroblast activation and fibrosis while inducing ROS production, leading to a marked increase in 4-HNE expression. Given the role of 4-HNE as a marker of lipid peroxidation and its elevated levels in the SSc cell model, this study suggests that 4-HNE could serve as a potential biomarker for fibrosis in SSc. The findings highlight the importance of investigating the mechanisms of 4-HNE in fibrosis and suggest that targeting this pathway could offer new therapeutic opportunities for treating SSc.

Objective: To study the distribution characteristics of natural killer (NK) cells and their subsets in normal peripheral blood in China, and to explore their normal value and significance. Methods: In this study, peripheral blood was collected from 200 healthy adults. Their age range was 18-87 years. All the subjects were divided into 6 age groups: 18-30, 31-40, 41-50, 51-60, 61-70, and 71-87 years. With CD16, CD56, CD4, CD19, as surface markers, fluid cytology detection techniques were used to detect NK cells and the relative and absolute counts. SPSS 27.0 was used for systematic analysis of the data, and the measurement data were expressed as mean±standard deviations. A t test, variance analysis or rank sum test were performed to compare the differences between the age groups and the sex groups. The significance level was set at α=0.05, and P < 0.05 was considered statistically significant. Results: The range of NK B cells in the 200 healthy adult subjects was (0.46±0.24)×10⁶/L, that of CD3^-CD56⁺NK cells was (13.14±7.56)×10⁶/L, that of CD56^dimCD16⁺NK cells was (5.23±3.12)×10⁶/L, that of CD56^brightNK cells was (85.61±7.40)×10⁶/L, and that of NK T cells was (4.16±3.34)×10⁶/L. There were no statistically significant differences in CD3^-CD56⁺NK cells and NK T cells with respect to age (P= 0.417, P=0.217). However, there was a decreasing trend in the number of NK B cells and CD56^dimCD16⁺NK cells with increasing age (r=0.234, P < 0.001; r=0.099, P < 0.001), particularly after the age of 50. Conversely, CD56^brightNK cells showed an increasing trend with age (r=0.143, P < 0.001). Conclusion: The detection of NK cells and their subsets has significant reference value for the diagnosis, treatment, and prognosis of autoimmune diseases, infectious diseases, and tumors. This study provides a preliminary reference range for clinical detection of NK cell subsets, but further research with a larger sample size and multi-center trials are needed to confirm these findings.

Objective: The triply periodic minimal surface (TPMS) Gyroid porous scaffolds were built with identical porosity while varying pore sizes were used by fluid mechanics finite element analysis (FEA) to simulate the in vivo microenvironment. The effects of scaffolds with different pore sizes on cell adhesion, proliferation, and osteogenic differentiation were evaluated through calculating fluid velocity, wall shear stress, and permeability in the scaffolds. Methods: Three types of gyroid porous scaffolds, with pore sizes of 400, 600 and 800 μm, were established by nTopology software. Each scaffold had dimensions of 10 mm × 10 mm × 10 mm and isotropic internal structures. The models were imported to the ANSYS 2022R1 software, and meshed into over 3 million unstructured tetrahedral elements. Boun- dary conditions were set with inlet flow velocities of 0.01, 0.1, and 1 mm/s, and outlet pressure of 0 Pa. Pressure, velocity, and wall shear stress were calculated as fluid flowed through the scaffolds using the Navier-Stokes equations. At the same time, permeability was determined based on Darcy' s law. The compressive strength of scaffolds with different pore sizes was evaluated by ANSYS 2022R1 Static structural analysis. Results: A linear relationship was observed between the wall shear stress and fluid velocity at inlet flow rates of 0.01, 0.1 and 1 mm/s, with increasing velocity leading to higher wall shear stress. At the flow velocity of 0.1 mm/s, the initial pressures of scaffolds with pore sizes of 400, 600 and 800 μm were 0.272, 0.083 and 0.079 Pa, respectively. The fluid pressures were gradually decreased across the scaffolds. The average flow velocities were 0.093, 0.078 and 0.070 mm/s, the average wall shear stresses 2.955, 1.343 and 1.706 mPa, permeabilities values 0.54×10^-8 1.80×10^-8 and 1.89×10^-8 m² in the scaffolds with pore sizes of 400, 600 and 800 μm. The scaffold surface area proportions according with optimal wall shear stress range for cell growth and osteogenic differentiation were calcula-ted, which was highest in the 600 μm scaffold (27.65%), followed by the 800 μm scaffold (17.30%) and the 400 μm scaffold (1.95%). The compressive strengths of the scaffolds were 23, 26 and 34 MPa for the 400, 600 and 800 μm pore sizes. Conclusion: The uniform stress distributions appeared in all gyroid scaffold types under compressive stress. The permeabilities of scaffolds with pore sizes of 600 and 800 μm were significantly higher than the 400 μm. The average wall shear stress in the scaffold of 600 μm was the lowest, and the scaffold surface area proportion for cell growth and osteogenic differentiation the largest, indicating that it might be the most favorable design for supporting these cellular activities.

Objective: To evaluate the wound healing of recipient and donor sites following keratinized mucosa augmentation (KMA) around implants in reconstructed jaw areas and to compare these outcomes with gingival grafts in native jawbone, so as to provide clinical guidance for postoperative maintenance, and to investigate the impact of clinical experience on the evaluation of KMA postoperative healing through subgroup comparisons. Methods: This study included patients who underwent resection of maxillofacial tumors, fibular or iliac flap reconstruction, and implant placement at Peking University Dental Hospital from October 2020 to April 2023. Three months post-implant placement, the patients were referred for KMA procedures. Clinical photographs of the reconstructed area were taken preoperatively, immediately postoperatively, and 3 weeks and 3 months post-surgery. Additionally, photographs of the palatal donor site were obtained preoperatively and 3 weeks later. Wound healing was assessed by four junior and three senior clinicians utilizing the early healing index (EHI), early wound healing score (EHS), and pink esthetic score (PES).And senior clinicians evaluated the healing effect compared with gingival transplantation on natural jawbone using a 10-point scale. Results: A total of 26 patients with jawbone reconstruction were included, with an average age of (34.2±10.2) years, 11 males (42.3%) and 15 females (57.7%). Among them, 13 cases (50.0%) underwent fibula flap reconstruction, and 13 cases (50.0%) underwent iliac flap reconstruction. The average number of implants per patient was 3.2±0.7. In the recipient area, 3 weeks postoperatively, the EHS was 7.0 (4.0, 9.0), with sub-item scores as follows: Clinical signs of re-epithelialization (CSR) 6.0 (3.0, 6.0), clinical signs of haemostasis (CSH) 1.5 (1.0, 2.0), and clinical signs of inflammation (CSI) 1.0 (0.0, 1.0), indicating that the average appearance of the wound in the recipient area was characterized by generally well-approximated wound edges with minimal fibrin lines and mild erythema and swelling. The EHI for the recipient area was 2.0 (1.5, 2.5), suggesting that the incision was mostly closed with some fibrin lines 3 weeks postoperatively. The long-term healing evaluation system, PES, was 2.5 (2.0, 3.0), with sub-scores for color [1.0 (1.0, 1.5)] and texture [1.5 (1.0, 2.0)], which were slightly different from the reference values.In the palatal donor area, 3 weeks postoperatively, the EHI score was lower at 1.3 (1.0, 2.5), while the EHS score was higher at 8.5 (6.0, 10.0), indicating better soft tissue healing in the donor area compared with the recipient area. Among the clinicians with different levels of experience, the assessment of wound healing revealed that except for the CSI sub-item, where the junior group scored higher than the senior group, all other sub-items showed significantly higher scores in the senior group compared with the junior group. In the EHS evaluation system, the CSH sub-item demonstrated no significant differences between the groups with varying levels of experience. Experienced clinicians' evaluation outcomes of healing effect compared with gum graft on natural alveolar bone was 8.5 (7.5, 9.5), showing high consistency [intraclass correlation coefficient (ICC): 0.892; 95% confidence interval (CI): 0.791－0.949], suggesting slightly suboptimal healing results after KMA surgery. Conclusion: The healing process following KMA in the context of jawbone reconstruction is relatively protracted, emphasizing the necessity for comprehensive postoperative management. Moreover, clinician experience plays a significant role in the assessment of wound healing outcomes for KMA in maxillofacial reconstruction.

Objective: To measure the concentration of growth differentiation factor-15 (GDF-15) in the serum of patients with atrial fibrillation (AF), to study the correlations between the levels of GDF-15 and different factors including basic clinical information, biochemical examinations, and atrial structure, and further to explore the association between GDF-15 and AF types and structural remodeling. Methods: AF patients who were admitted to the ward of the Department of Cardiology at Peking University Third Hospital between October 2017 and October 2019 were prospectively enrolled. Patients admitted to the ward at the same time with sinus rhythm and no prior AF history were enrolled in the control group. Clinical information and blood samples of the patients were collected. Enzyme-linked immunosorbent assay was used to measure the concentration of GDF-15. SPSS 23.0 was used for statistical analysis. Results: In the study, 156 AF patients (64 persistent AF and 92 paroxysmal AF) and 38 patients of the control group were included. Serum GDF-15 levels in the AF group were significantly higher than in the control group [1 112 (723, 1 525) ng/L vs. 697 (499, 825) ng/L, P < 0.001]. Serum GDF-15 levels in the persistent AF group were significantly higher than in the paroxysmal AF group [1 140 (858, 1 708) ng/L vs. 1 090 (662, 1 374) ng/L, P=0.047]. The area under the curve (AUC) of serum GDF-15 levels for prediction of AF was 0.736 (95%CI: 0.651-0.822, P < 0.001). The cut-off value was 843.2 ng/L with a sensitivity of 68.2% and a specificity of 78.9%. The AUC of serum GDF-15 levels for prediction of persistent AF was 0.594 (95%CI: 0.504-0.684, P=0.047). The cut-off va-lue was 771.5 ng/L with a sensitivity of 82.8% and a specificity of 35.9%. Spearman rank correlation analysis showed that the serum GDF-15 levels were positively correlated with age (r=0.480, P < 0.001), left atrial pressure (LAP, r=0.300, P < 0.001), and also negatively correlated with left atrial appendage flow velocity (LAAV, r=-0.252, P=0.002). Multiple linear regression analysis showed that age and LAP affected the GDF-15 levels significantly (P < 0.05). Logistic regression analysis suggested GDF-15 (OR=1.002, 95%CI: 1.001-1.003, P=0.004) and left atrial diameter (LAD, OR=1.400, 95%CI: 1.214-1.616, P < 0.001) were independent predictors of AF. Conclusions: Serum GDF-15 levels are higher in AF patients. Meanwhile, serum GDF-15 levels are higher in persistent AF patients than paroxysmal AF patients. GDF-15 is associated with AF and atrial structural remodeling.

Objective: To analyze the clinicopathological characteristics and prognosis of patients with multilocular cystic renal neoplasm of low malignant potential and compare the clinicopathological characteristics of patients with multilocular cystic renal neoplasm of low malignant potential who underwent different surgical methods. Methods: Clinicopathological data and prognosis of patients admitted to Peking University Third Hospital from January 2010 to September 2023 were collected. Patients who underwent radical nephrectomy or nephron-sparing surgery and were pathologically diagnosed with multilocular cystic renal neoplasm of low malignant potential were identified. Based on the surgical methods, the patients were divided into radical nephrectomy group and nephron-sparing surgery group. The clinicopathological characteristics of the two groups were compared. Results: A total of 35 patients were enrolled in this study. The median age at diagnosis was 53.0 (39.0-62.0) years. Among the 35 patients, 23 were males (65.7%) and 12 were females (34.3%). Nine patients underwent radical nephrectomy (25.7%), while 26 patients underwent nephron-sparing surgery (74.3%). The clinical T-stage of 35 patients did not exceed T2a stage. The median operation time was 145.0 min, and the median estimated intraoperative blood loss was 20.0 mL. The median postoperative hospitalization days was 6.0 d. The postoperative pathological results did not indicate renal sinus invasion, sarcomatous change, adrenal invasion or lymph node invasion. Based on the surgical methods, the patients were divided into a radical nephrectomy group and a nephron-sparing surgery group. There was no significant difference in clinicopathological charac-teristics between the two groups. Except for one patient who was lost to the follow-up, all the other patients were followed up for 8-111 months, with a median follow-up time of 70.5 months. Only one patient died from non-cancer-specific reasons, other patients had no tumor metastasis or recurrence. Conclusion: Patients with multilocular cystic renal neoplasm of low malignant potential have a good prognosis. There is no significant difference in clinicopathological characteristics of patients between nephron-sparing surgery group and radical nephrectomy group for multilocular cystic renal neoplasm of low malignant potential.

Objective: To evaluate the efficacy of modified femoral neck osteotomy (mFNO) in the surgical treatment of patients with ankylosing spondylitis (AS) and severe spinal kyphosis combined with hip flexion contracture. Methods: A retrospective analysis was conducted on 61 AS patients (103 hips) with spinal kyphosis and hip flexion contracture who underwent pedicle subtraction osteotomy (PSO) and total hip arthroplasty (THA) from January 1, 2019 to November 15, 2023. Data on mFNO operation time, blood loss, preoperative and postoperative values of the angle of the trunk and lower limb (ATL), hip passive range of motion (ROM), visual analogue scale (VAS), and incidence of in-hospital complications were recorded. Statistical analysis was performed using paired-samples t test. P < 0.05 was considered statistically significant. Results: The study ultimately included 10 cases, 9 males and 1 female, with an average age of (41.30±9.03) years. These patients underwent surgery for a total of 52 times, including 19 hips both receiving mFNO and THA, and 14 times PSO. The average operation time for nine bilateral mFNO was (133.11±34.81) min, with blood loss of (433.33±187.10) mL. A unilateral mFNO took 60 min with 200 mL of blood loss. The preoperative ATL of 19 hips was 40.37°±13.66°, and the postoperative ATL value was 88.47°±12.46° (P < 0.05). The preoperative VAS score was 0, while the postoperative VAS score was 5.95±1.51 (P < 0.05). The preoperative hip extension ROM was 37.37°±18.13°, while the postoperative hip extension ROM was -4.95°±21.24° (P < 0.05). Hip flexion ROM improved from 37.37°±18.13° to 50.79°±20.36° after FNO (P < 0.05). There were three cases of in-hospital complications (3/52, 5.67%): One case of postoperative atelectasis following PSO (1/52, 1.92%), one greater trochanter fracture identified during THA (1/52, 1.92%), and one early dislocation post-THA (1/52, 1.92%). Conclusion: mFNO significantly improves the ATL in AS patients with severe spinal kyphosis combined with hip flexion contracture, facilitating PSO and THA surgeries.

Objective: To analyze the clinical characteristics of patients with severe fall injury and explore the prehospital factors affecting the injury severity score (ISS). Methods: Clinical data of severe trauma patients with fall injury and ISS≥16 from January 2018 to December 2020 were retrieved from trauma database of Peking University People' s Hospital. The patients' age, gender, suicidal tendencies, psychiatric disorders, fall height, properties of the impact surface, the body part hitting the ground, abbreviated injury scale, Glasgow coma scale (GCS), length of stay in intensive care unit (ICU), operation were collected. And the in-hospital mortality were calculated. Univariate analysis and multiple linear regression models were used to analyze the relationship between the above factors and ISS. The patients' GCS, length of stay in ICU, surgery, and in-hospital mortality were collected to analyze the general clinical characteristics of patients. Results: A total of 160 patients were finally eligible, including 138 males and 22 females, with an average age of (45.56±15.85) years. Among the 160 patients, there were 36 cases (22.50%) with suicidal tendencies, 12 cases (7.50%) with psychiatric disorders. Their average fall height was (7.20±8.33) meters, and 48 cases (30.00%) hit the soft contact medium. 40 cases (25.00%) with impact on the head at the ground, lower limbs in 26 cases (16.25%), ventral in 16 cases (10.00%), dorsal in 40 cases (25.00%), lateral in 38 cases (23.75%). The patients' ISS was 22.8±6.85, GCS was 13.49±3.39, lengths of ICU stays were (9.96±8.12) days, and 142 (88.75%) patients underwent surgery, 8 in-hospital deaths were all due to head trauma, with an in-hospital mortality rate of 5.00%. Univariate analysis suggested that the main factors influencing ISS were the presence of suicidal tendencies (P=0.01) and the site of impact on the ground (P=0.02). Multiple linear regression analysis indicated that suicidal tendencies and head impact on the ground were in-fluential factors for high ISS. Conclusion: Collecting prehospital information of patients with fall injuries, such as whether they have suicidal tendencies and whether they hit the ground with their heads, can effectively predict the severity of patients' injuries, which is conducive to early diagnosis, early care, and early treatment, thus reducing preventable death.

Objective: To propose a novel neural network to achieve tooth instance segmentation and recognition based on cone-beam computed tomography (CBCT) voxel data. Methods: The proposed methods included three different convolutional neural network models. The architecture was based on the Resnet module and built according to the structure of "Encoder-Decoder" and U-Net. The CBCT image was de-sampled and a fixed-size region of interest (ROI) containing all the teeth was determined. ROI would first through a two-branch "encoder and decoder" structure of the network, the network could predict each voxel in the input data of the spatial embedding. The post-processing algorithm would cluster the prediction results of the relevant spatial location information according to the two-branch network to realize the tooth instance segmentation. The tooth position identification was realized by another U-Net model based on the multi-classification segmentation task. According to the predicted results of the network, the post-processing algorithm would classify the tooth position according to the voting results of each tooth instance segmentation. At the original spatial resolution, a U-Net network model for the fine-tooth segmentation was trained using the region corresponding to each tooth as the input. According to the results of instance segmentation and tooth position identification, the model would process the correspon-ding positions on the high-resolution CBCT images to obtain the high-resolution tooth segmentation results. In this study, CBCT data of 59 cases with simple crown prostheses and implants were collected for manual labeling as the database, and statistical indicators were evaluated for the prediction results of the algorithm. To assess the performance of tooth segmentation and classification, instance Dice similarity coefficient (IDSC) and the average Dice similarity coefficient (ADSC) were calculated. Results: The experimental results showed that the IDSC was 89.35%, and the ADSC was 84. 74%. After eliminating the data with prostheses artifacts, the database of 43 samples was generated, and the performance of the training network was better, with 90.34% for IDSC and 87.88% for ADSC. The framework achieved excellent performance on tooth segmentation and identification. Voxels near intercuspation surfaces and fuzzy boundaries could be separated into correct instances by this framework. Conclusions: The results show that this method can not only successfully achieve 3D tooth instance segmentation but also identify all teeth notation numbers accurately, which has clinical practicability.

Objective: To investigate the prognostic factors for all-cause mortality in patients with muscle-invasive bladder cancer (MIBC) with intermediate-to-high-risk primary prostate cancer. Methods: From January 2012 to October 2023, the clinical data of the patients with MIBC with intermediate-to-high-risk primary prostate cancer in Peking University Third Hospital were retrospectively analyzed. All the patients were monitored and the occurrence of all-cause death was documented as the outcome event in the prognostic study. Univariate and multivariate Cox proportional risk regression analysis models were implemented to search for independent influences on the prognosis of patients. For significant influencing factors (pathological T stage, M stage and perineural invasion of bladder cancer), survival curves were plotted before and after multifactorial Cox regression adjusting for confounding factors. Results: A total of 32 patients were included in this study. The mean age was (72.5±6.6) years; the median preoperative total prostate specific antigen (tPSA) was 6.68 (2.47, 6.84) μg/L; the mean preoperative creatinine was (95±36) μmol/L, and the median survival time was 65 months. The majority of the patients (87.5%) had high-grade bladder cancer, 53.1% had lymphatic invasion, and 31.3% had perineural invasion. Prostate involvement was observed in 25.0% of the cases, and the positive rate of soft-tissue surgical margin was 37.5%. Multivariate Cox analysis revealed that preoperative creatinine level (HR=1.02, 95%CI: 1.01-1.04), pathological stage of bladder cancer T3 (HR=11.58, 95%CI: 1.38-97.36) and T4 (HR=19.53, 95%CI: 4.26-89.52) metastasis of bladder cancer (HR=9.44, 95%CI: 1.26-70.49) and perineural invasion of bladder cancer (HR=6.26, 95%CI: 1.39-28.27) were independent prognostic factors (P < 0.05). Survival curves with Log-rank test after adjusting for confounding factors demonstrated that bladder cancer pathology T3, T4, M1, and perineural invasion were unfavorable factors affecting the patients' survival prognosis (P < 0.05). Conclusion: Patients with MIBC with intermediate-to-high risk primary prostate cancer generally portends a poor prognosis. High preoperative serum creatinine, T3 or T4 pathological stage of bladder cancer, metastasis of bladder cancer and bladder cancer perineural invasion are poor prognostic factors for patients with MIBC with intermediate-to-high risk primary prostate cancer.

Objective: To explore the association between polymorphisms of transforming growth factor-β (TGF-β) signaling pathway and non-syndromic cleft lip with or without cleft palate (NSCL/P) among Asian populations, while considering gene-gene interaction and gene-environment interaction. Methods: A total of 1 038 Asian NSCL/P case-parent trios were ascertained from an international consortium, which conducted a genome-wide association study using a case-parent trio design to investigate the genes affec-ting risk to NSCL/P. After stringent quality control measures, 343 single nucleotide polymorphism (SNP) spanning across 10 pivotal genes in the TGF-β signaling pathway were selected from the original genome-wide association study(GWAS) dataset for further analysis. The transmission disequilibrium test (TDT) was used to test for SNP effects. The conditional Logistic regression models were used to test for gene-gene interaction and gene-environment interaction. Environmental factors collected for the study included smoking during pregnancy, passive smoking during pregnancy, alcohol intake during pregnancy, and vitamin use during pregnancy. Due to the low rates of exposure to smoking during pregnancy and alcohol consumption during pregnancy (<3%), only the interaction between maternal smoking during pregnancy and multivitamin supplementation during pregnancy was analyzed. The threshold for statistical significance was rigorously set at P =1.46×10^-4, applying Bonferroni correction to account for multiple testing. Results: A total of 23 SNPs in 4 genes yielded nominal association with NSCL/P (P<0.05), but none of these associations was statistically significant after Bonferroni' s multiple test correction. However, there were 6 pairs of SNPs rs4939874 (SMAD2) and rs1864615 (TGFBR2), rs2796813 (TGFB2) and rs2132298 (TGFBR2), rs4147358 (SMAD3) and rs1346907 (TGFBR2), rs4939874 (SMAD2) and rs1019855 (TGFBR2), rs4939874 (SMAD2) and rs12490466 (TGFBR2), rs2009112 (TGFB2) and rs4075748 (TGFBR2) showed statistically significant SNP-SNP interaction (P<1.46×10^-4). In contrast, the analysis of gene-environment interactions did not yield any significant results after being corrected by multiple testing. Conclusion: The comprehensive evaluation of SNP associations and interactions within the TGF-β signaling pathway did not yield any direct associations with NSCL/P risk in Asian populations. However, the significant gene-gene interactions identified suggest that the genetic architecture influencing NSCL/P risk may involve interactions between genes within the TGF-β signaling pathway. These findings underscore the necessity for further investigations to unravel these results and further explore the underlying biological mechanisms.

Objective: To analyze the clinical effects of intraoperative transesophageal echocardiography (TEE) in different surgical methods for nephrectomy combined with Mayo Ⅲ-Ⅳ inferior vena cave (IVC) tumor thrombectomy. Methods: In the study, 28 patients who did surgery of nephrectomy and Mayo Ⅲ-Ⅳ IVC thrombectomys in Peking University Third Hospital from 2022 January to 2024 February were included. Of the 28 patients, 16 patients did robotic surgery, 2 patients did laparoscopic surgery, and 10 patients did open surgery. All patients' clinical data were collected. Results: Intra-operative TEE was used in 9 robotic surgeries, of which 7 cases showed image changes compared with preoperative image results. Intraoperative TEE indicated that tumor thrombus entered the right atrium in 2 cases, showed that tumor thrombus grade rose from Mayo Ⅲ to Mayo Ⅳ in 2 cases, and indicated that tumor thrombus adhered to IVC wall in 3 cases. All of these surgical plans were timely adjusted. Intra-operative TEE was used in 6 cases of open surgery, and 4 cases of them showed Mayo grade changes compared with preoperative image results. Intraoperative TEE indicated that tumor thrombus adhered to the IVC wall in 3 cases, and tumor thrombus adhered to the IVC wall with thrombus in one case. The surgical plans were adjusted, and the tumor thrombus was left or segmentally removed. Laparoscopic surgery did not use intraoperative TEE. The effects of intraoperative TEE included: the combination of exploration and TEE monitoring was used in open surgery, and tumor thrombus removal process was fully monitored by intraoperative TEE in the robotic surgery. Intraoperative TEE real-time monitored circulatory status and cardiac function changes. Conclusion: In different surgical methods for nephrectomy combined with Mayo Ⅲ-Ⅳ tumor thrombectomy, intraoperative TEE can re-determine the tumor thrombus grade and degree of tumor thrombus adhered to IVC, track the tumor thrombus removal process in real-time, and monitor circulatory status and cardiac function changes. Intraoperative TEE plays an important role in different surgical methods, but its clinical application is still insufficient. Intraoperative TEE is recommended to such type of surgeries.

Objective: To analyze the factors related to spontaneous re-eruption after intruded injury in permanent anterior teeth in children and adolescents. Methods: Clinical data from 5- to 17-year-old patients who sustained intrusive luxation of permanent anterior teeth and treated in the Department of Pedia-tric Dentistry of Peking University School and Hospital of Stomatology from June 2015 to August 2024 were reviewed. Information of age, gender, degree of intrusion, direction of intrusion, tooth development, concomitant injuries, luxation and post-osteoclastic eruption of the adjacent teeth were recorded. The patients were divided into two groups based on whether they showed spontaneous re-eruption during advised observation after intrusion. Univariate and multifactor analysis were performed using Logistic regression. Results: Data from 170 teeth in 139 patients whose age ranging from 5.3-16.3 years [mean age (9.0± 2.1) years] were examined. A gender disparity was observed among the patients, with 84 being male and 55 being female. Among the 170 teeth, 112 were categorized as successfully spontaneous re-eruption during advised observation after intrusion, while 58 were not. In terms of the degree of intrusion, 45 teeth (26.47%) had intrusion less than 3 mm, 102 teeth (60.00%) experienced intrusion between 3-7 mm, and 23 teeth (13.53%) were faced with intrusion exceeding 7 mm. As for the direction of intrusion, 117 teeth (68.82%) were straight intrusion while mesial-distal and buccal-lingual intrusion respectively accounting for 17 (10.00%) and 23 (13.53%). Multivariate Logistic regression analysis showed that mesial-distal intrusion (OR=0.167, 95%CI: 0.031-0.9048, P=0.038), intrusion of >7 mm (OR=0.065, 95%CI: 0.014-0.299, P < 0.001) and luxation of adjacent teeth (OR=0.369, 95%CI: 0.144-0.944, P=0.037) were independent risk factors for spontaneous re-eruption of traumatically intruded permanent anterior teeth in children and adolescents during advised observation after intrusion, while intrusion of < 3 mm (OR=9.860, 95%CI: 2.430-40.009, P=0.001) and post-osteoclastic eruption of adjacent teeth (OR=4.712, 95%CI: 1.528-14.531, P=0.007) were independent protective factors. The possibility of spontaneous re-eruption in permanent anterior teeth during advised observation after intrusion was decreased by 61.1% with the increase of root development using Cvek' s classification (OR=0.611, 95%CI: 0.408-0.914, P=0.017). Age (OR=1.077, 95%CI: 0.763-1.521, P=0.673) and laceration of gingival (OR=0.865, 95%CI: 0.290-2.578, P=0.794) didn't significantly affect the spontaneous re-eruption during advised observation after intrusion. Conclusion: In this study, mesial-distal intrusion, intrusion of >7 mm and luxation of adjacent teeth were independent risk factors for spontaneous re-eruption of traumatically intruded permanent anterior teeth in children and adolescents during advised observation, while intrusion of < 3 mm and post-osteoclastic eruption of adjacent teeth were served as independent protective factors.

This study reports the diagnosis and treatment of a 26-year-old pregnant woman with severe malnutrition combined with acute pyelonephritis causing sepsis, refractory septic shock and multiple organ failure. A female patient, 26 years old, was admitted to hospital mainly due to "menelipsis for more than 19 weeks, nausea and vomiting for 20 days, fever with fatigue for 3 days". At the end of 19 weeks of intrauterine pregnancy, the patient presented with fever accompanied by urinary tract irritation. Laboratory tests showed elevated inflammatory indicators, and ultrasonography showed bilateral pelvicalyceal dilation. She was diagnosed with acute pyelonephritis, sepsis, acute kidney injury (AKI) and severe malnutrition. After a whole-hospital consultation, the patient was treated with meropenem and vancomycin as antimicrobial therapy, and bilateral nephrostomy drainage was performed simultaneously. After that, the patient suffered a sudden decrease in blood pressure, blood oxygen saturation, and rapid heart rate. Septic shock with multiple organ dysfunction was considered, and she was transferred to intensive care unit (ICU) immediately. After the patient was transferred to ICU, emergency tracheal intubation and ventilator-assisted ventilation were performed. Rapid fluid resuscitation was administered for the patient. While pulse indicator continuous cardiac output (PICCO) monitoring was performed, norepinephrine, terlipressin, and methylene blue were administered to maintain peripheral vascular resistance. Since the patient developed septic cardiomyopathy and cardiogenic shock later, levosimendan and epinephrine were admi-nistered to improve cardiac function. While etiological specimens were delivered, meropenem, teicoplanin and caspofungin were given as initial empiric antimicrobial therapy. Unfortunately, the intrauterine fetal death occurred on the night of admission to ICU. On the 3rd day of ICU admission, a still-born child was delivered vaginally with 1/5 defect of the fetal membrane. On the 6th day of ICU admission, the patient had fever again with elevated inflammatory indicators. After excluding infection in other parts, intrau-terine infection caused by incomplete delivery of fetal membrane was considered. Then emergency uterine curettage was performed and the infection gradually improved. Later the laboratory results showed that the nephrostomy drainage was cultured for Escherichia coli and uterine, cervical and vaginal secretions were cultured for Candida albicans. Due to severe infection and intrauterine incomplete abortion, the patient developed disseminated intravascular coagulation (DIC). Active antimicrobial therapy and blood product supplement were given. However, the patient was critically ill with significant decrease in hemoglobin and platelets combined with multiple organ failure. Thrombotic microangiopathy (TMA) was not excluded yet, so plasma exchange was performed for the patient in order not to delay treatment. The patient underwent bedside continuous renal replacement therapy (CRRT) for AKI. The patient was complicated with acute liver injury, and the liver function gradually returned to normal after liver protection, antimicrobial therapy and other treatments. Due to the application of large doses of vasoactive drugs, the extremities of the patient gradually developed cyanosis and ischemic necrosis. Local dry gangrene of the bilateral toes remained at the time of discharge. In general, the patient suffered from septic shock, cardiogenic shock, combined with DIC and multiple organ dysfunction. After infection source control, antimicrobial therapy, uterine curettage, blood purification treatment, nutritional and metabolic support, the patient was discharged with a better health condition.

Objective: To investigate the effect of interleukin-25 (IL-25) on ovalbumin (OVA) induced atopic dermatitis of mice, and the significance of regulating IL-25. Methods: In this study, 90 healthy male 6-week-old specific pathogen free (SPF) BALB/c mice were divided into 6 groups (15 in each group): ① subcutaneous injection of phosphate buffered saline (PBS) group (normal control group); ② subcutaneous injection of mouse IL-25 group (IL-25 group); ③ subcutaneous injection of anti-mouse IL-25 monoclonal antibody (anti-IL-25 group), each group received subcutaneous injection once a day for 1 week, 2 weeks apart, repeated daily subcutaneous injections for 1 week, 2 weeks apart, and repeated daily subcutaneous injections for 1 week, for a total of 7 weeks; ④ OVA treated group (model group); ⑤ OVA treated and IL-25 subcutaneous injection group (IL-25 treated dermatitis group); ⑥ OVA treated and anti-mouse IL-25 monoclonal antibody injection group (anti-IL-25 treated dermatitis group). The ⑤ and ⑥ groups in the process of treatment with OVA, IL-25 or anti-IL-25 antibody were given in the same way as the ② and ③ groups. Scratching behavior and skin performance of the mice were recorded during the seven-week-treatment. Twenty four hours after the final treatment, blood was taken from the mouse heart, and the serum was separated to detect the total IgE, IL-4, IL-5, IL-13, etc. The skin samples of the treatment sites were used for hematoxylin-eosin (HE) staining, immunohistochemistry, real-time PCR and Western blot detections. A single factor (ANOVA) analysis of variance was used to compare the differences in various indicators between the groups. Results: The frequency of scratches in the IL-25 treated dermatitis group was higher than that in the model group, and the scratching behavior of the anti-IL-25 treated dermatitis group was significantly lower than that in the model group. The appearance of atopic dermatitis, thickening of the epidermis and the degree of dermal inflammation in the IL-25 treated dermatitis group were more serious than those in the model group and the anti-IL-25 treated dermatitis group. The levels of serum IgE, IL-4, IL-5, and IL-13 in the IL-25 treated dermatitis group were significantly higher than that in the model group and the anti-IL-25 treated dermatitis group. There were significantly more CD4⁺ T cells in the dermis of IL-25 treated dermatitis group than that in the anti-IL-25 treated dermatitis group. The expression levels of filaggrin and defensin β2 proteins in the IL-25 treated dermatitis group were significantly lower than those in the model group and the anti-IL-25 treated dermatitis group. Conclusion: In the OVA induced atopic dermatitis mice model, IL-25 can significantly promote the damage of the epidermal barrier function and aggravate the OVA-induced dermatitis. Antagonizing IL-25 can alleviate OVA induced dermatitis to a certain extent.

Objective: To explore the effects of short-term particulate matter (PM) exposure and the melatonin receptor 1B (MTNR1B) gene on triglyceride-glucose (TyG) index utilizing data from Fang-shan Family-based Ischemic Stroke Study in China (FISSIC). Methods: Probands and their relatives from 9 rural areas in Fangshan District, Beijing, were included in the study. PM data were obtained from fixed monitoring stations of the National Air Pollution Monitoring System. TyG index was calculated by fasting triglyceride and glucose concentrations. The associations of short-term PM exposure and rs10830963 polymorphism of the MTNR1B gene with the TyG index were assessed using mixed linear models, in which covariates such as age, sex, and lifestyles were adjusted for. Gene-environment inter-action analysis was furtherly performed using the maximum likelihood methods to explore the potential effect modifier role of rs10830963 polymorphism in the association of PM with TyG index. Results: A total of 4 395 participants from 2 084 families were included in the study, and the mean age of the study participants was (58.98±8.68) years, with 53. 90% females. The results of association analyses showed that for every 10 μg/m³ increase in PM_2.5 concentration, TyG index increased by 0.017 (95%CI: 0.007-0.027), while for per 10 μg/m³ increment in PM₁₀, TyG index increased by 0.010 (95%CI: 0.003-0.017). And the associations all had lagged effects. In addition, there was a positive association between the rs10830963 polymorphism and the TyG index. For per increase in risk allele G, TyG index was elevated by 0.040 (95%CI: 0.004-0.076). The TyG index was 0.079 (95%CI: 0.005-0.152) higher in carriers of the GG genotype compared with carriers of the CC genotype. The interaction of rs10830963 polymorphism with PM exposure had not been found to be statistically significant in the present study. Conclusion: Short-term exposure to PM_2.5 and PM₁₀ were associated with higher TyG index. The G allele of rs10830963 polymorphism in the MTNR1B gene was associated with the elevated TyG index.

Objective: To comprehend the main characteristics and historical evolution of health financing transition in China. Methods: Data were collected from various sources, including the Global Health Expenditure Database (GHED), China Health Statistics Yearbook, National Health Finance Annual Report, China ' s Total Health Expenditure Research Report, et al. Descriptive statistics and literature study was conducted. Results: Since the beginning of the 21st century, most countries in the world had witnessed a transition of health financing, characterized by the expansion of health financing scale and the strengthening of public financing responsibility. Notably, China ' s health financing transition exhibited distinctive features. Firstly, there had been a more rapid expansion in health financing scale compared with global averages. Between 2000 and 2019, total health expenditure per capita experienced a remarkable increase of 816.6% at comparable prices, significantly surpassing average growth rates observed among other countries worldwide (102.1%). Secondly, greater efforts had been made to strengthen the responsibilities of public financing. From 2000 to 2019, there was a substantial decrease of 30.6 percentage points in the proportion of out-of-pocket health expenditure as a share of total health expenditure. This decline was significantly larger than the average reduction observed among other countries worldwide (5.6 percentage points). Thirdly, there had been a significant shift in government health expenditure allocation patterns, with an increased emphasis on "demand-side subsidies" surpassing "supply-side subsidies". Within the realm of "supply-side subsidies", funding directed towards hospitals had notably increased and surpassed that allocated to primary healthcare institutions and public health institutions. Based on these distinctive characteristics, this paper expanded China ' s health financing transition into three dimensions: Scale dimension, structure dimension and flow dimension. Using a comprehensive analytical framework, the history of China ' s health financing transition was roughly divided into four stages: The planned economy stage, the economic transition stage, the post-SARS stage and the new health system reform stage. The main features and evolutionary logic associated with each stage were analyzed. Conclusion: Above all, the health financing system should be enhanced in terms of vertical "embeddedness" and horizontal "complementarity". Moreover, the significance of health financing transition in preserving hidden value and mitigating public risk should be emphasized, and there is a need for an improved two-way trade-off mechanism that balances value and risk. Additionally, the ethical principles associated with health financing transition should be considered comprehensively, while optimizing budget decision-making within the government ' s actual governance model. Lastly, it is crucial to recognize the overall and profound impact of modern medicine development and explore long-term strategies and pathways for health financing transition in China.

Objective: To investigate the effect of tofacitinib, a pan-Janus kinase (JAK) inhibitor, on transforming growth factor-beta 1 (TGF-β1)-induced fibroblast to myofibroblast transition (FMT) and to explore its mechanism. To provide a theoretical basis for the clinical treatment of connective tissue disease-related interstitial lung disease (CTD-ILD). Methods: (1) Human fetal lung fibroblast 1 (HFL-1) were cultured in vitro, and 6 groups were established: DMSO blank control group, TGF-β1 induction group, and TGF-β1 with different concentrations of tofacitinib (0.5, 1.0, 2.0, 5.0 μmol/L) drug intervention experimental groups. CCK-8 was used to measure the cell viability, and wound-healing assay was performed to measure cell migration ability. After 48 h of combined treatment, quantitative real-time PCR (RT-PCR) and Western blotting were used to detect the gene and protein expression levels of α-smooth muscle actin (α-SMA), fibronectin (FN), and collagen type Ⅰ (COL1). (2) RT-PCR and enzyme-linked immunosorbnent assay (ELISA) were used to detect the interleukin-6 (IL-6) gene and protein expression changes, respectively. (3) DMSO carrier controls, 1.0 μmol/L and 5.0 μmol/L tofacitinib were added to the cell culture media of different groups for pre-incubation for 30 min, and then TGF-β1 was added to treat for 1 h, 6 h and 24 h. The phosphorylation levels of Smad2/3 and signal transducer and activator of transcription 3 (STAT3) protein were detected by Western blotting. Results: (1) Tofacitinib inhibited the viability and migration ability of HFL-1 cells after TGF-β1 induction. (2) The expression of α-SMA, COL1A1 and FN1 genes of HFL-1 in the TGF-β1-induced groups was significantly up-regulated compared with the blank control group (P < 0.05). Compared with the TGF-β1 induction group, α-SMA expression in the 5.0 μmol/L tofacitinib intervention group was significantly inhi-bited (P < 0.05). Compared with the TGF-β1-induced group, FN1 gene was significantly inhibited in each intervention group at a concentration of 0.5-5.0 μmol/L (P < 0.05). Compared with the TGF-β1-induced group, the COL1A1 gene expression in each intervention group did not change significantly. (3) Western blotting results showed that the protein levels of α-SMA and FN1 in the TGF-β1-induced group were significantly higher than those in the control group (P < 0.05), and there was no significant difference in the expression of COL1A1. Compared with the TGF-β1-induced group, the α-SMA protein level in the intervention groups with different concentrations decreased. And the differences between the TGF-β1-induced group and 2.0 μmol/L or 5.0 μmol/L intervention groups were statistically significant (P < 0.05). Compared with the TGF-β1-induced group, the FN1 protein levels in the intervention groups with different concentrations showed a downward trend, but the difference was not statistically significant. There was no difference in COL1A1 protein expression between the intervention groups compared with the TGF-β1-induced group. (4) After TGF-β1 acted on HFL-1 cells for 48 h, the gene expression of the IL-6 was up-regulated and IL-6 in culture supernatant was increased, the intervention with tofacitinib partly inhibited the TGF-β1-induced IL-6 gene expression and IL-6 in culture supernatant. TGF-β1 induced the increase of Smad2/3 protein phosphorylation in HFL-1 cells for 1 h and 6 h, STAT3 protein phosphorylation increased at 1 h, 6 h and 24 h, the pre-intervention with tofacitinib inhibited the TGF-β1-induced Smad2/3 phosphorylation at 6 h and inhibited TGF-β1-induced STAT3 phosphorylation at 1 h, 6 h and 24 h. Conclusion: Tofacitinib can inhibit the transformation of HFL-1 cells into myofibroblasts induced by TGF-β1, and the mechanism may be through inhibiting the classic Smad2/3 pathway as well as the phosphorylation of STAT3 induced by TGF-β1, thereby protecting the disease progression of pulmonary fibrosis.

Objective: To understand the nutritional status and physical fitness of the Uygur, Kazak and Han ethnic college students, and to investigate the nonlinear relationship between BMI and physical fitness indexes in different ethnic groups. Methods: A total of 3 600 Uygur, Kazakh and Han students majoring in non-sports in a university in Xinjiang Uygur Autonomous Region in 2021 were selected by stratified random cluster sampling method. Height, weight, vital capacity, 50 m running, standing long jump, sit-and-reach, sit-up/pull-up and endurance running were measured. Body mass index (BMI), standardized Z score of each test score and physical fitness index (PFI) were calculated. The data were analyzed by Chi-square test, single factor analysis of variance, and nonlinear quadratic regression. Results: Prevalences of overweight (16.00%) and obesity (8.08%) of the Han college students were significantly higher than those of the Uygur (11.83% and 4.08%) and Kazakh (13.58% and 4.58%). Prevalence of low weight in the Uygur (11.92%) was the highest, and the lowest was the Kazakh (9.75%). There were significant differences in the prevalence of BMI classification among the three ethnic groups boys and girls (all P < 0.05). There were significant differences in PFI among college students of different BMI levels in the Uygur, Kazakh and Han ethnic college students (all P < 0.05), and the PFI of normal weight group was higher than the other weight groups in general, and the overweight group was higher than the obese group, but some ethnics showed the highest PFI in the low weight group. The non-linear quadratic regression results showed that the curves of the Uygur boys and girls and the Kazakh boys were inverted "J" shaped, and the PFI increased and then decreased with the increase of BMI, while the rest of the curves were arc-shaped, and the PFI decreased with the increase of BMI. Conclusion: Overweight obesity in the Uygur, Kazakh and Han ethnic college students brings about a decrease in physical fitness, but Kazakh low weight male and female and Han low weight grils have better physical fitness than the normal weight groups. Focusing on improving the physical fitness of Uygur low-weight and high-weight boys and Han high-weight girls could effectively reduce the differences in physical fitness of college students in different weight levels and ethnic groups.

Objective: To investigate the diagnostic efficacy of targeted biopsy combined with regional systematic biopsy in prostate cancer (PCa) in patients with prostate imaging reporting and data system v2.1 (PI-RADS v2.1) 4-5. Methods: From January 2023 to October 2023, patients who underwent prostate biopsy for the first time with total prostate specific antigen (tPSA) ≤ 20 ng/mL and had a multi-parametric magnetic resonance imaging (mpMRI) PI-RADS of 4-5 in Peking University First Hospital were prospectively collected. All the patients underwent transrectal ultrasound-guided cognitive fusion targeted biopsy (3 cores) followed by systematic biopsy (12 cores). Various hypothetical biopsy schemes were defined based on different biopsy sites. The detection effectiveness of targeted biopsy combined with regional systematic biopsy and other biopsy schemes for prostate cancer were compared using Cochran's Q and McNemar tests. Results: A total of 255 patients were enrolled, of whom 204 (80.0%) were detected with prostate adenocarcinoma and 187 (73.3%) were clinically significant with prostate cancer (csPCa). The detection rate of PCa with targeted biopsy was significantly lower than that of targeted biopsy combined with 12-core system biopsy (77.3% vs. 80.0%, P=0.016), and 71.4% (5/7) of the missed patients was csPCa. There was no significant difference in the detection rate between targeted biopsy combined with 4-core regional system biopsy and 12-core system biopsy (P>0.999), and 1 case of csPCa and clinically insignificant prostate cancer (cisPCa) were missed. There was no significant difference in the detection rate of PCa between targeted combined regional system biopsy and targeted combined lateral or traditional 6-core system biopsy and the number of cores were reduced. Missed diagnosis of targeted biopsy was correlated with the maximum diameter of the lesion (OR=0.086, 95%CI: 0.013-0.562, P=0.010). For the patients with PI-RADS 5, only 1 case of PCa was missed in 122 cases by targeted biopsy alone. For patients with PI-RADS 4, 6 PCa cases were missed among the 133 patients with targeted biopsy alone, and 1 case of csPCa and cisPCa were missed by targeted biopsy combined with regional system biopsy. The statistics of positive core counts for different biopsy schemes indicated that targeted combined regional systematic biopsy had a higher proportion of positive cores second only to targeted biopsy alone. Conclusion: Targeted biopsy combined with regional systematic biopsy has high diagnostic efficacy in patients with PI-RADS 4-5 and can be considered as one of the improved schemes for combined biopsy. Targeted biopsy alone is also a feasible option for patients for patients with a PI-RADS score of 5.

Objective: To investigate the feasibility, safety and effectiveness of robot-assisted laparoscopic buccal mucosa graft ureteroplasty in the treatment of complex long proximal ureteral stricture. Methods: The clinical data of 20 patients with proximal ureteral stricture undergoing robot-assisted laparoscopic buccal mucosa graft ureteroplasty admitted to the Department of Urology, Peking University First Hospital and Beijing Jiangong Hospital from July 2022 to January 2023 were prospectively collected and analyzed. Intraoperative conditions, postoperative complications and follow-up data were also recorded and analyzed. Results: The operations under robot-assisted laparoscopy were performed successfully in all the 20 patients without conversion to traditional laparoscopic surgery or open surgery. The study included 14 males and 6 females with a mean age of (41±11) years (range: 19 to 60 years) and a mean body mass index of (24.3±3.6) kg/m² (range: 18.2 to 31.8 kg/m²). There were 9 cases on the left side and 11 cases on the right side. The strictures of all the patients were located in the proximal segment of the ureter (including the ureteropelvic junction). The mean preoperative serum creatinine was (92.2±23.3) μmol/L (range: 49.2 to 138.9 μmol/L), and the mean length of ureteral stricture was (2.8±0.9) cm (range: 1.0 to 4.0 cm). Ten patients had previously undergone unsuccessful reconstructive surgery. During the operation, 12 patients received posteriorly augmented anastomosis with ventral onlay. The mean length of the buccal mucosa graft harvested during the operation was (3.1±0.6) cm (range: 2.0 to 4.3 cm), and the median width was 1.5 cm (range: 1.0 to 2.0 cm). The omentum flap was used to wrap the reconstructed ureteral segment in all the 20 cases. The median operative time was 154 min (range: 113 to 300 min), and the median estimated blood loss was 45 mL (range: 0 to 100 mL). The median postoperative hospital stay was 4 d (range: 4 to 14 d). The mean postoperative follow-up time was (15.0±1.7) months (range: 12.5 to 17.9 months), and the surgical success rate was 100.0% in this study. After surgery, 11 patients reported mild discomfort at the oral donor site, 2 patients deve-loped urinary tract infection, and no postoperative complications were reported in the other 7 patients. The mean serum creatinine was (90.9±23.9) μmol/L (range: 60.0 to 153.0 μmol/L) six months after surgery. Conclusion: Robot-assisted laparoscopic buccal mucosa graft ureteroplasty for the treatment of complex long proximal ureteral stricture has satisfactory efficacy without severe complications, which has shown good feasibility, safety and effectiveness. However, large sample studies and long-term follow-up are still needed to evaluate its long-term efficacy.

Objective: To investigate the serum lactate level in patients with rheumatoid arthritis (RA) and its relationship with disease activity, and to analyze the effect of sodium lactate on the activation of CD4⁺ T cells, the ability of secreting cytokines and CD4⁺T cell subsets in peripheral blood of the RA patients. Methods: The peripheral blood of healthy controls (HC) and RA patients was collected, and the content of lactate in the supernatant was detected by lactate detection kit, the correlation between the content of lactate and the disease score of the RA patients was analyzed; the activation level of CD4⁺ T cells, the proportion of CD4⁺ T cell subsets and the cytokines secreted by CD4⁺ T cells in peripheral blood of all the RA patients were detected by flow cytometry after being stimulated with sodium lactate. Results: The serum lactate level in the RA patients (n=66) was significantly higher than that in the HC (n=60, P < 0.001), and there was a certain correlation with disease activity score in 28 joints (DAS28)-C-reactive protein (CRP) (r=0.273, P=0.029), The levels of rheumatoid factor [RF, 197.50 (26.03, 783.00) IU/mL vs. 29.30 (0.00, 102.60) IU/mL, P < 0.01], CRP [37.40 (11.30, 72.60) mg/L vs. 5.83 (2.36, 12.45) mg/L, P < 0.001], were increased in patients with the lactate concentration greater than 5 mmol/L were significantly higher than those in patients with the lactate concentration less than or equal 5 mmol/L, however, there was no significant difference in the expression of erythrocyte sedimentation rate [ESR, 42.00 (19.00, 77.00) mm/h vs. 25.00 (12.50, 45.50) mm/h, P>0.05] and anti-cyclic citrullinated peptied (CCP) antibody [82.35 (17.70, 137.00) RU/mL vs. 68.60 (25.95, 119.70) RU/mL, P>0.05]. Compared with the control group, the expression of PD-1 (46.15%±8.54% vs. 41.67%±9.98%, P < 0.001), inducible costimulatory molecule (ICOS, 5.77%±8.60% vs. 18.65%±7.94%, P < 0.01) and CD25 (25.89%±5.80% vs. 22.25%±4.59%, P < 0.01) on the surface of CD4⁺ T cells in the RA patients treated with sodium lactate was significantly increased. Compared with the control group, the proportion of Th17 (4.62%±1.74% vs. 2.93%±1.92%, P < 0.05) and Tph (28.02%±6.28% vs. 20.32%±5.82%, P < 0.01) cells in CD4⁺T cells of the RA patients in the sodium lactate treatment group increased. Compared with the control group, the expression of IL-21 (5.73%±1.59% vs. 4.75%±1.71%, P < 0.05) in CD4⁺T cells was up-regulated in the RA patients treated with sodium lactate. Conclusion: The level of serum lactate in RA patients is increased, which promotes the activation of CD4⁺T cells and the secretion of IL-21, and up-regulates the proportion of Th17 and Tph cells in the RA patients.

Objective: To analyze the association between the triglyceride-glucose (TyG) index and the risk of nephrolithiasis across various demographic and clinical subgroups, aiming to enhance early diagnosis and treatment of nephrolithiasis and promote personalized care in diverse populations. Methods: This cross-sectional study analyzed the medical records of 84 968 adults, stratified into three categories (low, middle, high) according to their TyG index scores. To evaluate the association between the TyG index and nephrolithiasis risk, multivariable Logistic regression models were employed, adjusting for potential confounders. Additionally, piecewise linear regression models were used to investigate the non-linear dynamics of the TyG index's relationship with nephrolithiasis risk. Subgroup analyses were performed to explore variations in the effects of the TyG index across different demographic and clinical populations. Results: Increasing TyG index was associated with a higher risk of nephrolithiasis, rising from 4.36% in the low group to 8.96% in the high group (P < 0.001). In adjusted models, males in the middle and high TyG index categories demonstrated significantly elevated risks of nephrolithiasis, with odds ratios of 1.18 (95%CI: 1.07-1.31, P=0.002) and 1.29 (95%CI: 1.15-1.45, P < 0.001), respectively. Conversely, in females, the association was not statistically significant post-adjustment (OR=0.98, 95%CI: 0.82-1.16, P=0.778). Among males, for each unit increment in the TyG index below the critical threshold of 8.98, there was a notable 40% escalation in the risk of developing nephrolithiasis (OR=1.40, 95%CI: 1.24-1.58, P < 0.001). Surpassing this threshold, the TyG index no longer conferred a significant increase in risk (OR=0.91, 95%CI: 0.78-1.06, P=0.24). Subgroup analyses indicated that this association remained stable regardless of age, BMI, or hypertension status. Conclusion: The TyG index is positively associated with the risk of nephrolithiasis in males, demonstrating a nonlinear dose-response relationship that becomes especially pronounced at certain index levels. This biomarker could potentially serve as a valuable clinical tool for identifying males who are at a high risk of developing nephrolithiasis, thereby enabling targeted preventive strategies. Further research is urgently needed to explore the underlying mechanisms and to verify the applicability of these results across different populations.

Objective: To compare the association between body mass index (BMI) trajectories determined by different methods and the risk of overweight in early childhood in a prospective cohort study, and to identify children with higher risk of obesity during critical growth windows of early childhood. Methods: A total of 1 330 children from Peking University Birth Cohort in Tongzhou (PKUBC-T) were included in this study. The children were followed up at birth, 1, 3, 6, 9, 12, 18, and 24 months and 3 years of age to obtain their height/length and weight data, and calculate BMI Z-score. Latent class growth mixture modeling (GMM) and longitudinal data-based k-means clustering algorithm (KML) were used to determine the grouping of early childhood BMI trajectories from birth to 24 mouths. Linear regression was used to compare the association between early childhood BMI trajectories determined by different methods and BMI Z-score at 3 years of age. The predictive performance of early childhood BMI trajectories determined by different methods in predicting the risk of overweight (BMI Z-score > 1) at 3 years was compared using the average area under the curve (AUC) of 5-fold cross-validation in Logistic regression models. Results: In the study population included in this research, the three-category trajectories determined using GMM were classified as low, medium, and high, accounting for 39.7%, 54.1%, and 6.2% of the participants, respectively. The two-category trajectories determined using the KML method were classified as low and high, representing 50. 3% and 49. 7% of the participants, respectively. The three-category trajectories determined using the KML method were classified as low, medium, and high, accounting for 31.1%, 47.4%, and 21.5% of the participants, respectively. There were certain differences in the growth patterns reflected by the early childhood BMI trajectories determined using different methods. Linear regression analysis found that after adjusting for maternal ethnicity, educational level, delivery mode, parity, maternal age at delivery, gestational week at delivery, children' s gender, and breastfeeding at 1 month of age, the association between the high trajectory group in the three-category trajectories determined by the KML method (manifested by a slightly higher BMI at birth, followed by rapid growth during infancy and a stable-high BMI until 24 months) and BMI Z-scores at 3 years was the strongest. Logistic regression analysis revealed that the three-category trajectory grouping determined by the KML method had the best predictive performance for the risk of overweight at 3 years. The results were basically consistent after additional adjustment for the high bound score of the child' s diet balanced index, average daily physical activity time, and screen time. Conclusion: This study used different methods to identify early childhood BMI trajectories with varying characteristics, and found that the high trajectory group determined by the KML method was better able to identify children with a higher risk of overweight in early childhood. This provides scientific evidence for selecting appropriate methods to define early childhood BMI trajectories.

Objective: To explore the clinical safety and effectiveness of self-draining ureteral stent with thread in kidney transplant recipients in renal transplantation. Methods: This study is a prospective cohort clinical study in the Department of Urology of Peking University People's Hospital from November 2022 to January 2024. The ureteral stent with thread group, in which a 2-0 Mersilene suture of 20-30 cm was used at the bladder end of the ureteral stent during the operation. On the 9th day after the operation, the suture attached to the end of the ureteral stent was expelled out of the urethral orifice with the urine when the catheter was removed. The ureteral stent could be removed along with the suture. As to the cystoscope group, a ureteral stent was routinely placed during kidney transplantation, and the ureteral stent was removed under local infiltration anesthesia through cystoscopy after the operation. The pain scores [numerical rating scale (NRS)-11] during catheter removal and the incidence of urinary tract infections were observed and compared between the two groups. t test was used to compare the pain scores of indwelling ureteral stents and ureteral stents removal between the two groups, and Chi-square test was used to compare the occurrence of urinary system complications within 3 months after operation between the two groups. P < 0.05 was considered statistically significant. Results: As of March 2024, all the recipients were followed up for an average of 6 months (3 to 12 months) postoperatively. A total of 46 kidney transplantation patients were included, with 21 in the ureteral stent with thread group and 25 in the cystoscope group. There were no statistically significant differences between the two groups in age distribution, male-to-female ratio, and deceased versus live donor grafts. Three months after renal transplantation, there were 15 cases of urinary tract infection in the cystoscope group and 4 cases in the ureteral stent with thread group (P=0.007). No significant urinary fistula, wound infection, or ureteral stenosis occurred in either group. No stent-related complications, stent migration, or stone formation were observed. The postoperative bladder spasm symptom scores for indwelling ureteral stents in the cystoscope group and the ureteral stent with thread group were 4.4±2.5 and 4.6±2.4, respectively, with no statistically significant difference (t=0.29, P=0.773). However, the pain scores during ureteral stent removal were 4.9±1.6 and 3.0±1.0 in the two groups, respectively, with a statistically significant diffe-rence (t=5.017, P < 0.001). The total costs of indwelling and removing ureteral stents in the cystoscopy group and the ureteral stent with thread group were 6 452.0 (5 539.5, 6 452.0) yuan and 3 225.0 (3 225.0, 3 225.0) yuan, respectively, and the difference was statistically significant (P < 0.001). Conclusion: Compared with the conventional transplanted kidney ureteral stent, the self-discharge ureteral stent technique with sutures is simpler, has a shorter ureteral stent inlay time, reduces the symptoms of bladder spasms, significantly reduces the cost of catheterization, and has fewer postoperative urinary system complications. It is a worthy improved surgical method to be promoted.

Objective: To investigate the impact of age, various hormonal levels, and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction (ED). Me-thods: A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography (CDDU) and intracavernosal injection test (ICI) at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023. Data were managed and processed using SPSS 29.0, and a multivariable Logistic regression analysis was conducted. Results: A total of 700 ED patients were included, with 380 showing negative ICI results and 320 positive. In the study, 84 patients had a peak systolic velocity (PSV) < 25 cm/s, while 616 had PSV≥25 cm/s; 202 patients had end-diastolic velocity (EDV)>5 cm/s, and 498 had EDV≤5 cm/s. 264 patients had abnormal PSV and/or EDV results, and 436 had normal results for both. Patients with vascular ED had significantly lower estrogen levels (t=-3.546, P < 0.001), lower testosterone levels (t=-2.089, P=0.037), and a higher rate of hyperglycemia (χ²=12.772, P=0.002) compared with those with non-vascular ED. The patients with arterial ED were older (t=3.953, P < 0.001), had a higher rate of hyperglycemia (χ²=9.518, P=0.009), and a higher estrogen/testosterone ratio (t=2.330, P=0.020) compared with those with non-arterial ED. The patients with mixed arteriovenous ED had higher age (t=3.567, P < 0.001), lower testosterone levels (t=-2.288, P=0.022), a higher rate of hyperglycemia (χ²=12.877, P=0.002), and a larger estrogen/testosterone ratio (t=2.096, P=0.037) compared with those with normal findings. Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED (OR=1.009, 95%CI: 1.004-1.014), and glucose≥7.0 mmol/L was a risk factor (OR=0.381, 95%CI: 0.219-0.661). Older age was a risk factor for arterial ED (OR=0.960, 95%CI: 0.938-0.982). Additionally, older age (OR=0.976, 95%CI: 0.958-0.993) and glucose levels of 5.6-6.9 mmol/L (OR=0.591, 95%CI: 0.399-0.876) were also risk factors for mixed arterio-venous ED. Conclusion: Hyperglycemia and aging may impair penile cavernous body vascular function, while higher levels of estrogen may have a protective effect on it.

Objective: To summarize the clinical characteristics of patients with renal angiomyolipoma (RAML) combined with inferior vena cava (IVC) tumor thrombus, and to explore the feasibility of partial nephrectomy and thrombectomy in this series of patients. Methods: The clinical data of patients diagnosed with RAML combined with IVC tumor thrombus in the Department of Urology of the Peking University Third Hospital from April 2014 to March 2023 were retrospectively analyzed, and demographic and perioperative data of RAML patients with IVC tumor thrombus were recorded and collected from Electronic Medical Record System, including age, gender, surgical methods, and follow-up time, etc. The clinical characteristics between classic angiomyolipoma (CAML) patients with IVC tumor thrombus and epithelioid angiomyolipoma (EAML) patients with IVC tumor thrombus were compared to determine the clinical characteristics of these patients. Results: A total of 11 patients were included in this study, including 7 patients with CAML with IVC tumor thrombus and 4 patients with EAML with IVC tumor thrombus. There were 9 females (9/11, 81.8%) and 2 males (2/11, 18.2%), with an average age of (44.0±17.1) years. 9 patients (9/11, 81.8%) experienced clinical symptoms, including local symptoms including abdominal pain, hematuria, abdominal masses, and systemic symptoms including weight loss and fever; 2 patients (2/11, 18.2%) with RAML and IVC tumor thrombus did not show clinical symptoms, which were discovered by physical examination. Among the 11 patients, 10 underwent radical nephrectomy with thrombectomy, of whom, 3 underwent open surgery (3/10, 30.0%), 2 underwent laparoscopic surgery (2/10, 20.0%), and 5 underwent robot-assisted laparoscopic surgery (5/10, 50.0%). In addition, 1 patient underwent open partial nephrectomy and thrombectomy. The patients with EAML combined with IVC tumor thrombus had a higher proportion of systemic clinical symptoms (100% vs. 0%, P=0.003), more intraoperative bleeding [400 (240, 3 050) mL vs. 50 (50, 300) mL, P =0.036], and a higher proportion of tumor necrosis (75% vs. 0%, P=0.024) compared to the patients with CAML combined with IVC tumor thrombus. However, there was no statistically significant difference in operation time [(415.8±201.2) min vs. (226.0±87.3) min, P=0.053] between the two groups. Conclusion: Compared with the patients with CAML and IVC tumor thrombus, the patients with EAML and IVC tumor thrombus had a higher rate of systemic symptoms and tumor necrosis. In addition, in the selected patients with CAML with IVC tumor thrombus, partial nephrectomy and tumor thrombectomy could be performed to better preserve renal function.