Objective To investigate the role of luteolin (Lut) in regulating reactive oxygen species (ROS) levels through nuclear factor erythroid 2-related factor 2 (NFE2L2)/cystine glutamate antitransporter (x-CT)/glutathione peroxidase 4 (GPX4) signaling axis to inhibit the viability of glioblastoma and promote apoptosis. Methods U87 MG and U251 cells were cultured in vitro. The CCK-8 assay was used to detect cell survival rates after 48 hours of treatment with different concentrations (0, 6.25, 12.5, 25, 50 and 100 μmol/L) of Lut. According to whether cells were treated with Lut, cells were divided into the U87 control group, the U87 Lut group, the U251 control group and the U251 Lut group. The half-maximal inhibitory concentration (IC₅₀) at 48 hours was used as the unified treatment concentration for subsequent experiments. The apoptosis level of cells was detected by flow cytometry double staining method. Changes of reactive oxygen species (ROS) levels in cells were detected by the DCFH-DA method. Molecular docking was conducted using AutoDock software to verify the proteins related to the Lut and oxidative stress pathway. Real-time fluorescence quantitative reverse transcription (RT-qPCR) was used to detect the mRNA levels of NFE2L2 and GPX4. The expression levels of NFE2L2, x-CT and GPX4 proteins were detected by Western blot assay. Results After U87 MG and U251 cells were treated with Lut for 48 hours, the cell viability was significantly inhibited, and with the increase of Lut concentration, the cell viability decreased (P<0.05). Compared with the U87 control group and the U251 control group respectively, the apoptosis rate of cells increased in the U87 Lut group and the U251 Lut group, the green fluorescence intensity was enhanced, and the intracellular ROS level was upregulated (P<0.05). Results of molecular docking showed that Lut was tightly bound to NFE2L2, x-CT and GPX4. The results of RT-qPCR and Western blot assay showed that compared with the U87 control group and the U251 control group respectively, the protein and mRNA levels of NFE2L2 and GPX4 in cells of the U87 Lut group and the U251 Lut group, as well as the expression level of x-CT protein, decreased (P<0.05). Conclusion Lut regulates ROS levels through the NFE2L2/x-CT/GPX4 signaling axis to inhibit the viability of glioblastoma and promote cell apoptosis.

Objective To explore the therapeutic mechanism of berberine in atopic dermatitis (AD) rats based on PI3K/Akt/NF-kappa B signaling pathway. Methods Sixty adult male Wistar rats were randomly divided into the blank group (normal rats), the control group (AD model, 50 mg/kg berberine treatment) and the experimental group (AD model, 200 mg/kg berberine treatment), with 20 rats in each group. The levels of interleukin-4 (IL-4), interleukin-13 (IL-13) and tumor necrosis factor-α (TNF-α) were determined by enzyme-linked immunosorbent assay (ELISA) at 1 d, 7 d and 14 d of intervention. The protein levels of PI3K, p-PI3K, Akt, p-Akt and NF-κB p65 were detected by Western blot assay. Pathological changes of rat skin tissue were analyzed by HE staining. Results After intervention for 1 d, 7 d and 14 d, serum levels of IL-4, IL-13, TNF-α and PI3K, p-PI3K, Akt, p-Akt and NF-kappa B p65 were higher in the control group than those in the blank group (P<0.05). After intervention for 7 d and 14 d, the levels of the above indicators were lower in the experimental group than those in the control group (P<0.05). After 14 days of intervention, compared with the blank group, the skin tissue of rats in the control group and the experimental group showed obvious pathological changes, including thickening of epidermis layer, excessive keratinization of the stratum corneum, thickening of spinous layer and a large infiltration of inflammatory cells in dermis. The pathological damage of rat skin tissue was significantly alleviated in the experimental group. Conclusion Berberine can inhibit the activation of PI3K/Akt/NF-kappa B signaling pathway, reduce serum level of inflammatory factors and reduce pathological damage of skin tissue in AD rats.

Objective To assess the predictive value of proprotein convertase subtilisin/kexin type-9 (PCSK9) combined with lactic acid (Lac) and Sequential Organ Failure Assessment (SOFA) score in determining the 28-day mortality risk of patients with sepsis. Methods A total of 203 patients with sepsis were followed up for 28 days. Patients were divided into the death group (n=56) and the survival group (n=147) according to the clinical outcome. The general data and clinical indicators were compared between the two groups. The prediction model of 28 day mortality risk of sepsis patients was established by multivariate Logistic regression analysis, and the nomogram of the prediction model visualization was drawn. Results Alanine aminotransferase, serum creatinine, blood urea nitrogen, Lac, PCSK9 and SOFA score were higher in the death group than those in the survival group (P<0.05), while the hemoglobin level was lower than that in the survival group (P<0.05). The multivariable Logistic regression analysis identified that elevated levels of Lac (OR=1.197, 95%CI: 1.019-1.435), PCSK9 (OR=1.002, 95%CI: 1.001-1.003) and SOFA score (OR=1.858, 95%CI: 1.528-2.340) were independent risk factors for 28-day mortality in patients with sepsis (P<0.05). Nomogram was developed using these three indicators, and the linear predictor cutoff value was -1.06. Patients were divided into the low-risk group (n=126) and the high-risk group (n=77). The 28-day mortality rates were 4.0% for the low-risk group and 66.2% for the high-risk group. Internal validation showed that the model with these three indicators had good discrimination (C-index=0.924, 95%CI: 0.881~0.960, P<0.05), calibration (χ²=11.543, P>0.05) and clinical utility. Conclusion The combination of serum PCSK9, Lac and SOFA scores at admission effectively predicts 28-day mortality risk in sepsis patients.

Objective To investigate the efficacy of surface electromyography biofeedback combined with respiratory training on post-stroke dysphagia and its impacts on serum neuron specific enolase (NSE) and insulin-like growth factor 1 (IGF-1) in patients. Methods Totally 120 patients with post-stroke dysphagia in our hospital were stochastically assigned into the control group and the combined group, with 60 patients in each group. Both groups were given conventional treatment first, while the control group received respiratory training treatment. The combined group received surface electromyography biofeedback treatment on the top of the control group. The efficacy, serum NSE, central nervous system specific protein (S100β), IGF-1, functional oral intake scale (FOIS) score, standard swallowing function assessment scale (SSA) score, respiratory function, pharyngeal contraction rate and duration of pharyngeal contraction were compared between the two groups. Results After treatment, the total effective rate was higher in the combined group (χ²=4.876, P<0.05). Compared with before treatment, NSE, S100β, SSA score and pharyngeal contraction rate decreased after treatment in both groups, and those were even lower in the combined group (t=5.193, 9.000, 8.976, 10.614, P<0.05). Compared with before treatment, IGF-1, FOIS score, force vital capacity (FVC), forced expiratory volume in one second (FEV₁), peak expiratory flow rate (PEF) and duration of pharyngeal contraction increased after treatment in both groups, with even higher levels in the combined group (t=4.212, 6.220, 3.765, 6.935, 5.020, 4.249, P<0.05). Conclusion Surface electromyography biofeedback combined with respiratory training can improve neuronal damage in patients with dysphagia, enhance swallowing efficiency, reduce serum NSE, S100β levels and pharyngeal retention time, with significant curative effect.

Objective To construct and validate a nomogram prediction model for poor prognosis in elderly patients with gastrointestinal bleeding. Methods A total of 176 elderly patients with gastrointestinal bleeding were enrolled as the research objects. According to the prognosis during hospitalization, patients were divided into the poor prognosis group (56 cases) and the good prognosis group (120 cases). The clinical data of the two groups of patients were collected. The best variables of poor prognosis were screened by Lasso regression model, and the selected variables were included in the multivariate Logistic regression model to analyze the influencing factors. Nomogram was constructed based on the above influencing factors. Receiver operating characteristic (ROC) curve, clinical calibration curve and decision curve analysis (DCA) were drawn to validate clinical practicability of nomogram prediction model. Results Multivariate Logistic regression analysis showed that urea nitrogen (BUN, OR=2.766, 95%CI: 1.066-7.175) and high level of shock index (SI, OR=3.853, 95%CI: 1.028-14.446) were independent risk factors of poor prognosis in elderly patients with gastrointestinal bleeding (P<0.05), while high levels of albumin (ALB, OR=0.100, 95%CI: 0.036-0.277) were protective factors (P<0.05). ROC curve validated that the area under the curve of the prediction model was 0.845 (95%CI: 0.786-0.904). Calibration curve showed that the model had a relatively high degree of calibration. DCA showed that the model had a clear positive net benefit. Conclusion The nomogram prediction model constructed based on BUN, SI and ALB levels to predict the poor prognosis of elderly patients with gastrointestinal bleeding has a high predictive value.

Objective To explore the correlation between serum chemokine C-C ligand 21 (CCL21), NOD like receptor protein 3 (NLRP3) and hemorrhagic transformation (HT) after mechanical thrombectomy in patients with acute cerebral infarction (ACI). Methods A total of 210 ACI patients who underwent mechanical thrombectomy were selected and divided into the HT group (19 cases) and the non HT group (191 cases) based on the re-examination of head CT 24-hours after treatment. The differences in clinical data and serum levels of CCL21 and NLRP3 were compared between two groups. Multivariate Logistic regression analysis was used to analyze the influencing factors of HT occurrence. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum CCL21 and NLRP3 for HT. Results The proportion of atrial fibrillation, anterior circulation infarction and preoperative National Institutes of Health Stroke Scale (NIHSS) scores were higher in the HT group than those in the non HT group (P<0.05). The preoperative serum levels of CCL21 and NLRP3 were higher in the HT group than those in the non HT group (P<0.05). The Logistic regression model analysis results showed that atrial fibrillation, anterior circulation infarction, preoperative NIHSS score, CCL21 and NLRP3 were risk factors for postoperative HT in ACI patients (P<0.05). The application of receiver operating characteristic (ROC) curve analysis results showed that the area under the curve (AUC) for predicting HT occurrence by CCL21 was 0.850 (95%CI: 0.763-0.936). The AUC predicted by NLRP3 was 0.787 (95%CI: 0.703-0.871), and the combined detection of the two further improved the predictive value (AUC=0.921, 95%CI: 0.867-0.976). Conclusion CCL21 and NLRP3 are closely related to the occurrence of HT in ACI patients after mechanical thrombectomy, and which are influencing factors for the occurrence of HT after mechanical thrombectomy.

Objective To analyze the expression levels of matrix metalloproteinase-10 (MMP-10) and Toll-like receptor 2 (TLR2) in serum of patients underwent decompression surgery (DC) for severe traumatic brain injury (sTBI), and to explore their relationship with disease outcome. Methods From April 2021 to April 2024, sTBI patients (n=94) who received DC treatment in a single center were collected as the observation group. Another 90 healthy volunteers who underwent physical examinations at our hospital were selected as the control group. Six months after surgery, sTBI patients were assigned into the good group (n=53) and the adverse group (n=41) according to the Glasgow Outcome Scale (GOS). Data was collected from each group and their differences were compared. Enzyme linked immunosorbent assay (ELISA) was used to measure serum levels of MMP-10 and TLR2. Spearman method was used to analyze the correlation between MMP-10, TLR2 levels and disease outcomes. Logistic regression model used to analyze influencing factors of disease outcomes in sTBI patients after DC. The receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of serum MMP-10 and TLR2 levels for disease outcome in sTBI patients after DC. Results Compared with the control group, the expression levels of serum MMP-10 and TLR2 were prominently higher in the observation group (P<0.05). Compared with the good group, the proportions of sTBI patients with cerebral herniation, multiple brain contusions and lacerations, and serum levels of MMP-10 and TLR2 were significantly higher in the adverse group, while Glasgow Coma Scale (GCS) score was significantly lower (P<0.05). Serum levels of MMP-10 and TLR2 in sTBI patients were positively correlated with poor prognosis after DC (P<0.05). Elevated levels of serum MMP-10 and TLR2, and the increased proportions of patients with cerebral herniation and multiple brain contusions were risk factors affecting the disease outcome after DC in sTBI patients, while elevated GCS score was a protective factor (P<0.05). The area under the curve (AUC) for predicting disease outcome in sTBI patients after DC using serum MMP-10 and TLR2 alone and in combination was 0.839 (95%CI: 0.749-0.907), 0.847 (95%CI: 0.758-0.913) and 0.925 (95%CI: 0.852-0.969), respectively. The combined detection was superior to the individual detections (Z_{combination -MMP-10}=2.199, Z_{combination - TLR2}=2.377, both P<0.05). Conclusion The expression levels of serum MMP-10 and TLR2 in sTBI patients are significantly elevated, and both are prominently correlated with disease outcome after DC.

Objective To investigate the expression levels and clinical significance of serum and placental microRNA (miR) -1227-3p and miR-212-3p in puerperas with fetal growth restriction (FGR). Methods A total of 120 puerperas diagnosed with FGR and completed delivery in our hospital were included as the study group. Patients were assigned into the mild group (n=72) and the severe group (n=48) according to the severity of their condition. Another 120 healthy puerperas who underwent prenatal check ups and delivered during the same period in our hospital were included as the control group. QRT-PCR was used to detect serum and placental miR-1227-3p and miR-212-3p. The pregnancy outcomes of both groups were recorded, including neonatal weight, 1min Apgar score, placental weight and placental volume. Results Serum and placental miR-1227-3p expression levels, neonatal weight, 1 min Apgar score, placental weight and placental volume were significantly lower in the study group than those of the control group (P<0.05), while serum and placental miR-212-3p expression levels were significantly higher than those of the control group (P<0.05). The expression levels of miR-1227-3p in serum and placenta of the severe group were obviously lower than those of the mild group (P<0.05), while the expression level of miR-212-3p was obviously higher than those of the mild group (P<0.05). The expression levels of miR-1227-3p in serum and placenta were positively correlated with neonatal weight, 1 min Apgar score, placental weight and placental volume, and the expression levels of miR-212-3p in serum and placenta were negatively correlated with the above indicators (P<0.05). Multivariate Logistic regression analysis revealed that elevated serum and placental miR-212-3p levels were risk factors for FGR (P<0.05), and increased serum and placental miR-1227-3p, neonatal weight, 1 min Apgar, placental weight and placental volume were protective factors (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the diagnostic value of combined detection of serum and placenta miR-1227-3p and miR-212-3p levels for FGR was better than that of single diagnosis. Conclusion The combined detection of miR-1227-3p and miR-212-3p in serum and placenta of FGR puerperas has certain value in the clinical diagnosis of FGR.

Objective To explore the predictive value of serum procalcitonin (PCT), peripheral blood complement C3, C4 and lymphocyte subsets CD3⁺, CD4⁺ and CD8⁺ cells for plastic bronchitis (PB) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods A total of 222 children with RMPP were selected and divided into the PB group (51 cases) and the non-PB group (171 cases) based on whether they were complicated with PB. The serum PCT level of the children at admission was detected by fluorescence immunoquantitative analyzer, and levels of complement C3 and C4 were detected by immunoturbidimetry. The proportions of CD3⁺, CD4⁺ and CD8⁺T lymphocytes were detected by flow cytometry. Multivariate Logistic regression analysis was conducted to analyze influencing factors of PB in children with RMPP. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of the indicators. Results The levels of PCT and CD8⁺T cells and the duration of fever were higher in the PB group than those in the non-PB group, while the levels of complement C3 and CD4⁺T cells were lower than those in the non-PB group (P<0.05). Elevated levels of PCT and CD8⁺T cells were risk factors for the occurrence of PB in children with RMPP, while elevated levels of complement C3 and CD4⁺T cells were protective factors for the occurrence of PB in children with RMPP (P<0.05). The AUCs of PCT, complement C3, the proportion of CD4⁺T cells and the proportion of CD8⁺T cells predicted separately were 0.763, 0.802, 0.788 and 0.802 respectively, and the AUC of combined prediction was 0.915. The AUCs of individual predictions were all lower than those of the combined AUC (Z=3.199, 2.825, 3.112 and 2.514, P<0.05). Conclusion PCT, complement C3, CD4⁺ T cell ratio, and CD8⁺ T cell ratio are influencing factors for the occurrence of PB in children with RMPP, and their combined detection is beneficial for the early prediction of PB.

Objective To evaluate the clinical efficacy of selective expansive open-door laminoplasty (SEOLP) with preservation of C7 spinous process in the treatment of multisegmental cervical spondylotic myelopathy and its impact on changes in sagittal parameters of cervical spine. Methods A retrospective analysis was conducted on the clinical data and radiological information of 73 patients who underwent expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy in our department between March 2018 and June 2022. Patients were divided into the SEOLP group (n=35) and the EOLP group (n=38) based on the surgical method. Follow-up was conducted for one year. The operation time, blood loss, axial symptom scores, JOA scores, VAS scores and neck disability index (NDI) were recorded in two groups of patients. Radiological data were also recorded for both groups during the perioperative period, and the C2-7 Cobb angle, C2-7 SVA and T1 slope were measured. The cervical curvature index (CCI) and cervical range of motion (ROM) were calculated. The perioperative clinical outcomes and changes in cervical sagittal parameters were observed, and their correlations were analyzed. Results There were no significant differences in blood loss, operation time, JOA scores at various follow-up time points between the two groups (P>0.05). During postoperative follow-up, axial symptoms were observed in 5 patients in SEOLP group and 14 patients in EOLP group. There were statistically significant differences in axial symptom scores, incidence and severity of axial symptoms between the two groups (P<0.05). The NDI indices at one year after operation were 21.1±2.3 for SEOLP group and 24.8±3.5 for EOLP group respectively (P<0.01). There were no statistically significant differences in T1 slope and C2-7 Cobb angle at various follow-up time points after surgery between the two groups (P>0.05). One year after operation, CCI indices for two groups were (13.4±2.7) and (12.1±2.4), respectively, with a statistically significant difference (t=2.178, P<0.05). The C2-C7 SVA values for two groups at one year after operation were (22.4±3.8) mm and (26.7±5.9) mm, respectively (t=3.667, P<0.01). The results of the correlation analysis showed that there was a significant negative correlation between clinical functional improvement (NDI) and changes of the radiological parameter C2-C7 SVA in both groups of patients. Conclusion After SEOLP, the recovery of C2-C7 SVA is faster and has less impact on cervical spine function, and the occurrence degree and incidence of axial symptoms are lower.

Objective To investigate the effect of arthroscopic exploration combined with unicompartmental replacement surgery on knee joint function in patients with knee osteoarthritis. Methods Totally 82 patients with knee osteoarthritis in our hospital from August 2021 to February 2024 were included and stochastically divided into the control group and the observed group, with 41 patients in each group. Using a single-blind design, both groups received routine treatment first, while the control group received unicompartmental replacement surgery. The observation group was treated with arthroscopic exploration combined with unicompartmental replacement. Knee joint scoring criteria (HSS), Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (VAS) scores, quality of life, serum superoxide dismutase (SOD), malondialdehyde (MDA) and knee joint range of motion were compared between two groups. Results After treatment, HSS score, social function, physical function, overall health score, SOD and knee flexion angle increased in both groups (P<0.05), and the observed group was even higher (t=3.821, 4.027, 3.706, 3.957, 7.481 and 3.733, P<0.05). PSQI score, VAS score, MDA and tibiofemoral angle decreased in both groups, and the observed group was even lower (t=4.601, 8.375, 9.084 and 3.625, P<0.05). Conclusion Arthroscopic exploration combined with unicompartmental replacement surgery can effectively improve knee joint function and enhance the quality of life of patients with knee osteoarthritis.

Objective To explore the application effect of vertebroplasty (PVP) combined with precise personalized vertebral stent implantation based on 3D biomechanical modeling in the repair of thoracolumbar fractures. Methods A total of 98 patients with thoracolumbar vertebral fractures treated at our hospital from September 2021 to December 2022 were selected for this study. Patients were divided into two groups based on the surgical method: the conventional group (n=50) and the combined group (n=48). The conventional group received PVP treatment, while the combined group was treated with PVP combined with 3D-printed personalized vertebral body stents. The length of incision, operation time, blood loss, drainage volume and hospital stay of the two groups were recorded. The Oswestry Disability Index (ODI) was used to assess the improvement of thoracolumbar function in patients before surgery and one month after the surgery. Cobb angle, anterior height of injured vertebra and sagittal position index were measured. Visual Analog Scale (VAS) for pain and Short Form-36 (SF-36) questionnaire for quality of life were used to evaluate low back pain, lower extremity pain and quality of life of patients before surgery and one month after surgery. Postoperative complications were also recorded. Results The length of incision, operation time, blood loss, drainage volume and hospital stay were lower in the combination group than those of the conventional group (P<0.05). ODI score and Cobb angle were lower 1 month after surgery than those before surgery in both groups, and the combined group was lower than the conventional group (P<0.05). One month after operation, the anterior height and sagittal position index of injured vertebrae were higher than those before surgery, and the combined group was higher than the conventional group (P<0.05). VAS scores were lower and SF-36 scores were higher in both groups one month after operation compared to those before the operation, with the combined group showing lower VAS scores and higher SF-36 scores compared to the conventional group (P<0.05). The total complication rate was lower in the combined group (2.08%) than that in the conventional group (16.00%, P<0.05). There was no significant difference in the overall postoperative satisfaction between the conventional group and the combined group. Conclusion The treatment of thoracolumbar fractures with PVP combined with 3D printed personalized vertebral stenting has a remarkable effect. The pain and quality of life of patients have been significantly improved, and the surgical safety is relatively good.

Objective To investigate the clinical characteristics and risk factors of severe influenza B viral pneumonia complicated with invasive pulmonary aspergillosis. Methods Forty-six patients with severe influenza B virus pneumonia were collected and divided into the invasive pulmonary aspergillosis (IPA) group (17 cases) and the control group (29 cases) based on whether they were complicated with IPA. The clinical manifestations, laboratory indicators, chest CT imaging findings, bronchoscopic manifestations, broncho alveolar lavage fluid (BALF) culture and metagenomic next-generation sequencing results were compared between the two group. Treatment conditions and final treatment outcomes were also compared between the two groups. Univariate and multivariate Logistic regression analyses were conducted to explore risk factors of severe influenza B virus pneumonia complicated with IPA. Results After treatment, a total of 6 patients died (35.30%), all of whom were in the invasive pulmonary aspergillosis group. In both groups, the symptoms of dyspnea, cough, expectoration and chest pain were more severe, and systemic symptoms such as fatigue, fever and muscle pain were also quite obvious. There were no significant differences in clinical symptoms, combined bacterial infection and hormone use between the two groups. Compared with the control group, white blood cell count, neutrophil count, blood GM test and BALF GM test were higher in the combined group. The proportion of patients with nodules and patchy shadows on imaging and the proportion of patients showing pseudomembrane manifestations under bronchoscopy were higher (P<0.05). Univariate Logistic regression analysis showed that white blood cell count, GM in BALF, nodules and patchy shadows in lung imaging and pseudomembrane manifestations under bronchoscopy were influencing factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis (P<0.05). Multivariate Logistic regression analysis showed that GM ≥ 1 in BALF and pseudomembrane manifestations under bronchoscopy were risk factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis (P<0.05). Conclusion When GM test level of BALF in patients with severe influenza B virus pneumonia is ≥1 and pseudomembrane manifestations are seen under bronchoscopy, the possibility of combined invasive pulmonary aspergillus infection should be highly vigilant.

Objective To explore the effect of different pontic designs in resisting stress interruption effect and roller coaster phenomenon through three-dimensional finite element analysis, providing clinical guidance for the application of clear aligners in extraction cases. Methods Four three-dimensional finite element models of different pontic designs in the extraction area of clear aligners were established, including the pontic-free connection design, the conventional hollow pontic design, the partially solid-filled pontic design and the fully solid-filled pontic design. All four aligner models were individually assembled with the dental arch model. A 0.2 mm distal movement of the canine was simulated to observe the initial displacement and periodontal ligament stress distribution of canine and second premolar in each group of models. Results The initial displacement tendency diagram revealed that in all experimental conditions, both the canine and second premolar exhibited tipping movement patterns. However, significant variations in initial displacement magnitudes were observed across different pontic designs. The fully solid-filled pontic-connected clear aligner model exhibited the greatest initial displacement values (both crown and root) and the maximum initial displacement magnitude. Notably, this kind of design displayed movement characteristics closer to bodily movement, indicating superior control efficacy in tooth positioning. Periodontal ligament stress analysis revealed that the fully solid-filled pontic-connected clear aligner model generated the highest maximum principal stress in the periodontal ligament.Conclusion This three-dimensional finite element study reveals that the application of solid-filled pontic in clear aligner therapy could improve biomechanical control at extraction sites by minimizing aligner distortion, reducing stress interruption effect and preventing the roller coaster phenomenon.

Objective To investigate the effect of ventilation with different tidal volumes on respiratory mechanics and haemodynamics in children with severe pneumonia. Methods A total of 104 children with severe pneumonia were divided into the control group and the observation group using a random number table method, with 52 cases in each group. Both groups underwent mechanical ventilation treatment. The control group was treated with conventional tidal volume of 10-12 mL/kg, while the observation group was given a low tidal volume of 6-8 mL/kg. The respiratory mechanics indicators, hemodynamic indicators and inflammatory factor indicators before and after treatment were compared between the two groups. Results After treatment, the airway resistance (AR) and airway closing pressure (AOP) were lower in the observation group than those of the control group (P<0.05), and pulmonary dynamic compliance (Cdyn) was higher in the observation group than that of the control group (P<0.05). There were no significant differences in heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) after treatment between the two groups (P<0.05). After treatment, the levels of interleukin (IL）-6, IL-8 and tumor necrosis factor-α (TNF-α) were all lower in the observation group than those in the control group (P<0.05). Conclusion Small tidal volume mechanical ventilation is effective in improving the respiratory mechanics of children with severe pneumonia without causing large fluctuations in their hemodynamics. At the same time, it can reduce the level of inflammatory factors in the organism.

Objective To evaluate the risk of right heart failure after heart transplantation by establishing nomogram based on preoperative pulmonary artery pressure. Methods A total of 184 patients undergoing heart transplantation were retrospectively collected and divided into the training group (126 cases) and the verification group (58 cases). Patients in the training set were divided into the right heart failure group (60 cases) and the non-right heart failure group (66 cases) according to whether right heart failure occurred after operation. The differences of clinical data between the two groups were compared, and the influencing factors of right heart failure occurred after operation in the training set were screened by Lasso-Logistic regression. According to the screened influencing factors, nomograms were drawn, and the predictive efficiency of the model was evaluated by using the receiver's operating characteristic (ROC) curve, calibration curve, receiver's operating characteristic (ROC) curve and clinical decision curve. Further vertification of the clinical application effect of centralized evaluation model was conducted. Results The Lasso-Logistic regression analysis identified the following independent risk factors for right heart failure after heart transplantation: elevated total bilirubin (OR=2.649, 95%CI: 1.339-5.239), increased mean pulmonary artery pressure (OR=3.082, 95%CI: 1.608-5.910), elevated pulmonary artery resistance (OR=3.171, 95%CI: 1.710-5.879), and widened right ventricular outflow tract diameter (OR=2.681, 95%CI: 1.361-5.281), all of which demonstrated statistical significance (P<0.05). The nomogram model was constructed accordingly. The AUC of the nomogram model was 0.846 （95%CI: 0.813-0.947). The calibration curve demonstrated good fit via the goodness-of-fit test (Hosmer-Lemeshow χ²=0.862, P=0.361). Clinical decision curve analysis revealed that the net benefit rate remained >0 when the high-risk threshold probability ranged from 1% to 95%, indicating favorable clinical utility of this nomogram model. Based on the model predictions, among 58 heart transplant patients in the validation cohort, 34 were classified as high-risk for right heart failure and 24 as low-risk. Actual diagnosis results showed 29 cases with right heart failure and 29 without. The Kappa coefficient reached 0.483 (95%CI: 0.261-0.705), demonstrating high consistency between model predictions and actual clinical outcomes. Conclusion Preoperative pulmonary systolic pressure increase is an independent risk factor for right heart failure after heart transplantation. A nomogram prediction model for right heart failure after heart transplantation is established by combining other clinical risk factors, and it has good prediction efficiency.

Objective To explore the application value of serum heat shock protein 90α (Hsp90α) combined with β2-microglobulin (β2-MG) detection in the early diagnosis and prognosis of colorectal cancer (CRC). Methods A total of 101 patients with CRC who received their first treatment were selected as the CRC group (no surgery, radiotherapy or chemotherapy before enrollment), 100 patients with benign colon tumor admitted to our hospital during the same period were selected as the benign tumor group and 94 healthy individuals who underwent physical examinations in our hospital were used as the control group. The levels of serum Hsp90α and β2-MG in all subjects were detected by ELISA. Follow-up was conducted every three months within the first two years after surgery, and every six months in the third year, for a total follow-up period of 3 years, and the survival status of CRC patients within 3 years was recorded. ROC curve analysis was used to evaluate the diagnostic value of serum Hsp90α and β2-MG for CRC. The Kaplan-Meier method was used to draw the survival curves of CRC patients with different expression levels of Hsp90α and β2-MG. Results The serum levels of Hsp90α and β2-MG increased successively in the control group, the benign tumor group and the CRC group (P<0.05). There were no significant differences in serum levels of Hsp90α and β2-MG between CRC patients of different genders, ages and lesion locations. The levels of serum Hsp90α and β2-MG in patients with tumor diameter > 5 cm, low differentiation degree, TNM stage Ⅲ and lymph node metastasis were higher than those in patients with tumor diameter ≤ 5 cm, moderate to high differentiation degree, TNM stage Ⅰ-Ⅱ and no lymph node metastasis (P<0.05). The ROC results showed that the combined diagnostic efficacy of serum Hsp90α and β2-MG was superior to that of serum Hsp90α or β2-MG alone (Z = 2.433, 2.435, P<0.05). Based on the average expression levels of serum Hsp90α and β2-MG in CRC patients (76.66 μg/L and 6.52 μg/L), patients were divided into the high expression group of Hsp90α (59 cases), the low expression group of Hsp90α (42 cases), the high expression group of β2-MG (63 cases) and the low expression group of β2-MG (38 cases). Among the 101 CRC patients, 31 died and 70 survived, with a total survival rate of 69.31%. The Kaplan-Meier survival curve showed that the 3-year survival rates of patients with high expression levels of Hsp90α and β2-MG were lower than theose of patients with low expression levels of Hsp90α and β2-MG (P<0.01). Conclusion The expression levels of serum Hsp90α and β2-MG are both elevated in CRC patients, and they are closely related to the occurrence, development and prognosis of CRC.

Objective To observe the efficacy of Cuofeng San in the treatment of anterior circulation cerebral infarction (ACCI) of patients with syndrome of wind and phlegm blocking collaterals. Methods A total of 150 ACCI patients were collected in this study，and they were divided into the control group and the treatment group using a random number table method, with 75 cases in each group. The control group was given standardized intervention according to the stroke diagnosis and treatment guidelines, while the treatment group was treated with modified Cuofeng San on the basis of the control group. Both groups were treated continuously for 2 weeks. The treatment effects were compared between the two groups before and after treatment, including the National Institutes of Health Neurological Impairment Scale (NIHSS) score, Barthel Index (BI) score of daily activity ability, scores of syndrome of wind and phlegm blocking collaterals, serum levels of neuron specific enolase (NSE), S100 calcium binding protein B (S100B), monocyte chemoattractant protein-1 (MCP-1) and vascular endothelial cell calcium binding protein (VE-cadherin). Results The total effective rate of ACCI patients was higher in the treatment group than that in the control group (93.3% vs. 81.3%, P<0.05). After 1 week and 2 weeks of treatment, the NIHSS score and wind phlegm obstruction syndrome score decreased in both groups compared to those before treatment, while the BI score increased, and the improvement was more significant in the treatment group (P<0.05). After the end of the treatment course, serum levels of NSE, S100B, MCP-1 and VE-cadherin decreased compared to those before treatment, and the decrease was more significant in the treatment group (P<0.05). Conclusion The modified Cuofeng San has a significant effect on the treatment of wind phlegm obstruction syndrome in patients with ACCI acute phase. It can improve neurological function and enhance daily activity ability.

Objective To explore the therapeutic effect of Dangui Quyu Pill combined with acupuncture on adenomyosis (ADS) and its influences on serum levels of vascular endothelial growth factor (VEGF) and carbohydrate antigen 199 and 125 (CA199, CA125). Methods A total of 120 ADS patients were randomly divided into the control group (treated with acupuncture) and the treatment group (treated with Dangui Quyu Pills combined with acupuncture), with 60 cases in each group. The degree of dysmenorrhea before treatment and 6 months after treatment was evaluated by Visual Analogue Scale (VAS). Traditional Chinese Medicine (TCM) syndrome score was conducted. Uterine volume was detected by color Doppler ultrasound on the day of enrollment and 6 months after treatment (avoiding the menstrual period). Levels of VEGF, CA199 and CA125 were detected by ELISA before treatment and 6 months after treatment. The adverse reactions and recurrence of patients were observed and recorded. Results The total effective rate was higher in the treatment group than that of the control group (P<0.05). After treatment, the VAS score, TCM syndrome score, menstrual volume, uterine volume, serum levels of VEGF, CA199 and CA125 were lower in both groups than those before treatment, and the treatment group was even lower than those of the control group (P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups, and the recurrence rate of the treatment group was lower than that of the control group (P<0.05). Conclusion The combination of Dangui Quyu pill and acupuncture has obvious effect and high safety in the treatment of ADS.

Objective To explore curative effect of two thrombolytic regimens in the treatment of ultra-early acute cerebral infarction (ACI) of different age groups and different thrombolytic time windows. Methods A total of 166 patients with ACI were enrolled, with interval from onset to treatment ≤4.5 h. According to different thrombolytic regiments, patients were divided into the recombinant tissue plasminogen activator (rt-PA) group (104 cases, intravenous thrombolysis with 0.9 mg/kg rt-PA) and the tenecteplase (TNK) group (62 cases, intravenous thrombolysis with 0.25 mg/kg TNK). According to different age groups and different thrombolytic time windows, patients were divided into the high age group (≥70 years), the low age group (< 70 years), the short time window group (< 3 h) and the long time window group (3-4.5 h). After thrombolysis, laboratory indexes [neutrophil (NEU), lymphocyte (LYM)], scores of National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) and incidence of adverse events were compared in different groups by factorial analysis method. Results There was no significant difference in any index between the rt-PA group and the TNK group (P>0.05). Compared with the high age group at 7 d after thrombolysis, NIHSS score, NEU, neutrophil to lymphocyte ratio (NLR) and high sensitive C-reactive protein (hs-CRP) were lower, while LYM and albumin (ALB) were higher in the low age group (P<0.05). Compared with the long time window group, NEU and NLR were lower, while LYM was higher in the short time window group (P<0.05). There was no significant difference in total incidence of adverse events within 14 d of thrombolysis between the different age groups and the different thrombolytic time window groups (P>0.05). Conclusion For patients with ultra-early ACI, 0.9 mg/kg rt-PA and 0.25 mg/kg TNK have comparable efficacy in intravenous thrombolysis, and both have better effects when patient age is<70 years old and the thrombolysis time window is<3 hours.

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated episodes of upper airway collapse and obstruction during sleep. Polysomnography is the gold standard for diagnosing OSA, but it is expensive, time-consuming, and can cause discomfort for patients. In recent years, acoustic-based approaches for detecting OSA have emerged as a research focus. This review summarizes recent advances in OSA automatic detection techniques based on snoring and speech signals, and systematically examines their applications in diagnosis, severity assessment, and localization of obstruction sites. Findings indicate that the acoustic features of snoring and speech signals hold significant value for OSA screening, and when combined with machine learning and deep learning models, it can achieve high diagnostic accuracy. Future research should focus on elucidating the relationship between acoustic features and the pathophysiological mechanisms of OSA, integrating multimodal information, and advancing the clinical application of wearable devices, with the aim of promoting intelligent, non-invasive, and cost-effective screening technologies for OSA.