Objective: To explore the characteristics of the diversity and composition of oral microbial flora with age, and to provide a reference for understanding the succession of oral microecology at different ages. Methods: Oral rinse 16S rRNA (V4 region) sequencing data from 9 021 participants 14-69 years of age in the 2009-2012 National Health and Nutrition Examination Survey (NHANES) were analyzed. Alpha diversity (Observed OTUs, Faith’s PD, Shannon Index), beta diversity (Bray-Curtis and UniFrac), and genus-level composition were examined using weighted generalized linear models (GLMs), including quadratic terms for age and adjusting for key covariates (gender, race/ethnicity, BMI, smoking status, and periodontitis severity). Results: Alpha diversity demonstrated a clear inverted U-shaped trajectory across age, peaking at 25-30 years old and declining thereafter. This trend remained consistent across sex, race, smoking, and periodontal health strata. Beta diversity analyses revealed a modest but steady age-related shift in community structure. Genus-level analyses revealed that Rothia, Prevotella_6, and Lactobacillus increased steadily with age, while Haemophilus, Porphyromonas, and Corynebacterium declined significantly. Notably, potential periodontopathogens, such as Fusobacterium and Treponema_2, peaked in early adulthood before declining with age. Conclusion Age is an important driver of oral microbial succession, and the oral microbiome exhibits dynamic changes across different life stages. Future longitudinal and multi-omic studies are warranted to elucidate the mechanisms underlying these age-related trajectories.

Objective To evaluate the clinical efficacy of a novel sleep-aid decoction in treating elderly insomnia patients with different traditional Chinese medicine (TCM) constitutional types, and its effects on neurotransmitter and inflammatory factor levels. Methods A total of 200 patients with four different TCM constitutions-peaceful, Qi-deficient, Yin-deficient, and Yang-deficient-were recruited. Peripheral blood neurotransmitter and inflammatory factor levels were measured for variations among insomnia patients across different constitutions. These patients were treated using the novel sleep-aid decoction, the effects of which were evaluated based on changes in neurotransmitters and inflammatory factors. Results Compared to the peaceful constitution group, insomnia patients with Qi-deficient, Yin-deficient, and Yang-deficient constitutions exhibited significantly elevated baseline levels of neurotransmitters (5-HT, GABA) and inflammatory factors (IL-6, TNF-α, IL-1β, CRP). Following the treatment, the Qi-deficient and Yin-deficient groups showed a marked increase in 5-HT levels, restored balance of Glu, GABA, and melatonin, and significant reductions in IL-6 and TNF-α levels. The overall effective rate was 83.5%, with optimal efficacy observed in the Qi-deficient (97.72%) and Yin-deficient (95.34%) groups. Conclusion The novel sleep-aid decoction is effective in treating insomnia in elderly patients, with the best results observed in the Qi-deficient and Yin-deficient constitution groups.
Humans ; Sleep Initiation and Maintenance Disorders/blood* ; Aged ; Male ; Female ; Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional ; Middle Aged ; Tumor Necrosis Factor-alpha/blood* ; Sleep Aids, Pharmaceutical/therapeutic use* ; Anti-Inflammatory Agents/therapeutic use* ; Interleukin-6/blood* ; Interleukin-1beta/blood* ; Neurotransmitter Agents/blood* ; Aged, 80 and over ; C-Reactive Protein/metabolism*

ObjectiveTo investigate the relationship between the non-fasting triglyceride and glucose （TyG） index and hyperglycemia in pregnancy during the third trimester in high altitudes. MethodsThis study selected clinical and laboratory data of 774 Tibetan singleton pregnant women who delivered at Chaya People's Hospital of Qamdo city in Xizang autonomous region， from January 2023 to April 2025. The non-fasting TyG index was calculated from non-fasting triglyceride （TG） and random plasma glucose （PG）. Based on the tertiles of the non-fasting TyG index values， the individuals were split into three groups （corresponding to non-fasting TyG index of 8.89 and 9.21， respectively）. The baseline clinical characteristics， lipid levels and the occurrence of developing hyperglycemia in pregnancy were compared among the three groups. Statistical analyses were performed using ANOVA， Kruskal-Wallis H test， Chi-square test， or Fisher exact test and the relationship between the non-fasting TyG index and hyperglycemia in pregnancy were examined using multivariate logistic regression models and curve fitting. ResultsA total of 774 Tibetan singleton pregnant women were included， with a average age of 27.3 ± 6.1 years， a pre-delivery body mass index （Pre-BMI） of （25.2±2.3）kg/m² ， a proportion of 26.7% （207/774） primigravid women， the mean non-fasting TyG index was 9.1 ± 0.4。Thirty pregnant women were diagnosed with hyperglycemia in pregnancy， with a detection rate of 3.9% （30/774）. Statistically significant differences in serum total cholesterol （TC）， TG， low-density lipoprotein cholesterol （LDL-C） and high-density lipoprotein cholesterol （HDL-C） levels were identified when comparing different non-fasting TyG groups （all P values <0.05）. Subsequent trend test analysis indicated that the levels of TC， TG， LDL-C， and PG gradually increased with elevated the non-fasting TyG index （ F_{trend TC}=95.61， P<0.001； F_{trend TG}=1 051.91， P<0.001； F_{trend LDL-C} = 97.20， P < 0.001； F_{trend TG}=195.20； P<0.001）. After adjustment for maternal age， pre-delivery BMI， altitude， TC， LDL-C， and HDL-C， multivariate Logistic regression models revealed independent positive associations between non-fasting TyG index and hyperglycemia in pregnancy （Model 1： OR=2.72， 95% CI： 1.13-6.53， P=0.026； Model 2： OR=2.56， 95% CI： 1.01-6.50， P=0.048； Model 3： OR=2.72， 95% CI： 1.06-6.97， P=0.037； Model 4： OR=4.02， 95% CI： 1.42-11.40， P=0.009） and the incident of hyperglycemia in pregnancy showed an increasing tendency as increasing with the non-fasting TyG index， however， this association did not statistical significance （P _trend >0.05）. Curve fitting by restricted cubic splines （RCS） were used to assess linearity between non-fasting TyG and hyperglycemia in pregnancy， and there was a linear dose-response relationship between non-fasting TyG and hyperglycemia in pregnancy （P _{for non-linear} = 0.515）. ConclusionNon-fasting TyG index in the third trimester is a risk factor for hyperglycemia in pregnancy among the Tibetan singleton pregnant women at high altitudes and there was a possible linear dose-response relationship between the non-fasting TyG index and hyperglycemia in pregnancy.

Objective The objective of this study is to investigate whether there is a correlation between a high TyG index(serum triglyceride glucose index)and higher mortality rates among patients undergoing peritoneal dialysis(PD).Methods This study utilized a single-center retrospective cohort as the basis for its methods..From January 1,2007 to December 31,2015,a total of 519 PD patients kept under observation until December 31,2018.There searchers employed the Kaplan-Meier method and Cox proportional hazards modelsto examine the cor-relation between TyG index levels and mortality.Results Over a period of 40.5 months,104(20.0%)individuals with Parkinson's disease passed away,with 55(52.9%)of these deaths attributed to cardiovascular disease(CVD).The serum median TyG index at baseline was 8.44(6.48,11.94).Through Cox regression analysis subject to the adjustments of such parameters as gender,age,body mass index(BMI),presence of cardiovascular disease,hypertension,diabetes mellitus,hemoglobin,serum albumin,serum Ferritin,total cholesterol,renal residual function(RRF),An increased risk of all-cause mortality(HR = 2.22,95%CI:1.43～3.44,P＜0.001)and CVD mortality(HR = 2.50,95%CI:1.34～4.65,P = 0.004)was observed with a higher baseline TyG index(8.44).A comparable impact was observed in the correlation between the average TyG index over time(TA-TyG index)and both all-cause mortality and CVD mortality.(HR = 1.90,95%CI:1.25～2.90,P = 0.003;HR = 2.05,95%CI:1.14～3.70,P = 0.017,respectively).Conclusion PD patients with a higher serum TyG index have a greater risk of all-cause mortality and mortality related to cardiovascular disease.

Objective:To investigate the incidence and prothrombotic risk factors of postoperative venous thromboembolism(VTE) in Cushing′s disease and to further develop an assessment model to identify those at high risk of postoperative VTE events.Methods:A retrospective study was performed in 82 patients who were admitted to Huashan Hospital, Fudan University during January 2019 and January 2020 and diagnosed with Cushing′s disease. These patients underwent the evaluation about their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. The least absolute shrinkage and selection operator(LASSO) regression analysis was used to screen independent risk factors, and a nomogram model for postsurgical VTE risk assessment in Cushing′s disease was initially established, and Bootstrap method was used for internal verification. Finally, the predictive model was evaluated for calibration and clinical applicability in the study cohort.Results:Nineteen patients(23.17%) developed VTE events, with 14 cases occurring after endoscopic transsphenoidal surgery. Compared to patients without VTE, those in the VTE group were older( P<0.001), had longer postoperative bed rest, higher rates of current infection, higher HbA 1C levels, and more severe glucose tolerance impairment(all P<0.05). Through LASSO regression analysis, two independent risk factors for postoperative VTE were identified: Age and current infection. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In the nomogram model for VTE risk assessment, the area under the receiver operating characteristic curve was 0.868(95% CI 0.787-0.949), with the calibration curve closely aligning with the ideal diagonal line and the clinical decision curve exceeding the two extreme curves. Conclusions:Advanced perioperative assessment needs to be taken to screen those with high VTE risks in patients diagnosed with Cushing′s disease. Additionally, during the perioperative period, patients with Cushing′s disease should undergo mandatory physical activity or prophylactic anticoagulant therapy.

Objective:To analyze the dermoscopic and reflectance confocal microscopic (RCM) features of extragenital lichen sclerosus, and to identify their associations with histopathological manifestations.Methods:A total of 57 patients with histopathologically confirmed lichen sclerosus were retrospectively collected from the Department of Dermatology, Wuhan No.1 Hospital from October 2010 to April 2024. Dermoscopic and RCM images were collected from typical skin lesions in extragenital areas, and the consistency between dermoscopic or RCM characteristics and histopathological features was analyzed.Results:Among the 57 patients with extragenital lichen sclerosus, there were 15 males and 42 females, with ages ranging from 5 to 60 years and disease duration from 5 to 28 months. The skin lesions were mainly located on the face and neck (23 cases, 40.4%) and back (11 cases, 19.3%). Histopathological features included hyperkeratosis with follicular plugging, vacuolar degeneration of basal cells, edematous papillary and superficial dermis, collagen homogenization, and predominant infiltration of variable amounts of melanophages and lymphocytes in the superficial dermis. Dermoscopy showed yellowish-white structureless areas in 57 cases (100%), yellowish-white circular structures in 55 (corresponding to follicular keratotic plugs, 96.5%), characteristic vascular structures in 54 (94.7%), gray-brown punctate pigmentation in 56 (98.3%), xanthochromic patchy pigmentation in 20 (35.1%), white scales in 54 (94.7%), white scar-like hypopigmentation in 43 (75.4%), and hemorrhagic spots in 2 (3.5%). RCM images showed follicular plugging in 44 cases (77.19%), manifesting as dilated follicular infundibula containing highly refractive keratotic materials; liquefaction degeneration of the basal cell ring was observed in 57 cases (100%), manifesting as loss of the basal cell ring, blurred epidermal-dermal junction, and infiltration of variable amounts of melanophages and inflammatory cells in the superficial dermis; dilatation of superficial dermal blood vessels was seen in 46 (80.7%) ; all 57 cases (100%) showed reduced epidermal thickness compared to surrounding normal skin, epidermal atrophy and thinning, and rete ridge flattening; hyperkeratosis was observed in 57 cases (100%) ; 39 cases (68.42%) showed thickened fibers with increased refractivity in the superficial dermis. The detection rates of follicular keratotic plugs, patchy pigmentation, and white scar-like hypopigmentation by dermoscopy significantly differed from those by histopathological examinations (all P < 0.05), so did the detection rates of superficial dermal collagen thickening and vascular dilatation by RCM (both P < 0.05) . Conclusions:Extragenital lichen sclerosus has characteristic dermoscopic and RCM manifestations, which were highly consistent with its histopathological findings. Dermoscopy combined with RCM technology can provide effective support for the diagnosis and differential diagnosis of extragenital lichen sclerosus.

Hepatic stellate cell(HSC)activation is a key link in the development of liver fibrosis.The metabolic reprogramming of activated HSC has become a hot topic in current research,especially the change of glycolysis is an important factor in regulating HSC activation.Based on the metabolic reprogramming in the process of HSC activation,this paper expounds the mechanism of regulating HSC activation and liver fibrosis through glycolysis,and reviews the research progress of traditional Chinese medicine and its active ingredients in regulating HSC glycolysis to prevent and treat liver fibrosis.Liver fibrosis is a complex pathological process involving multiple factors and pathways.From the perspective of regulating the glycolysis of activated HSC,it can provide a new idea for the development of anti-liver fibrosis drugs.

Objective To investigate the effects of remazolam on melatonin secretion,sleep rhythm and postoperative delirium(POD)in elderly patients undergoing spinal surgery.Methods A total of 160 elderly patients,76 males and 84 females,aged 65-80 years,BMI 18.5-24.0 kg/m2,ASA physical status Ⅱ or Ⅲ,from November 2023 to January 2024 undergoing spinal surgery(lumbar interbody fusion,posterior approach)under general anesthesia were selected.The patients were divided into two groups by random number table method:the remazolam group(group R)and the propofol group(group P),80 pa-tients in each group.Group R was given remazolam 0.3 mg/kg for anesthesia induction,and then continued to pump remazolam 0.3-0.8 mg·kg-1·h-1 for anesthesia maintenance.Group P was given propofol 2.0 mg/kg for anesthesia induction,and then continued to pump propofol 4-6 mg·kg-1·h-1 for anesthesia maintenance.The levels of melatonin and cortisol were recorded at 04:00 a.m.on the day of surgery,1 day,2 and 3 days after surgery.Pittsburgh sleep quality index(PSQI)and VAS pain scores at rest were recorded 1 day before surgery,1 day and 2 days after surgery and before discharge.The occurrence of POD and post-operative sleep disorder(POSD)were recorded.The duration of extubation,PACU stay time,total analgesia pump compressions,effective analgesia pump compressions,number of remedial analgesia cases,intraoperative hypotension,postoperative nausea and vomiting,dizziness,respiratory depression and other adverse events were recorded.Results Compared with group P,the extubation time and PACU residence time in group R were significantly shortened(P＜0.05),the level of melatonin was significantly increased while the level of cortisol was significantly decreased at 4:00 a.m.,and the PSQI was significantly decreased 1 day after surgery(P＜0.05),the incidence of POD,POSD,and intraoperative hypotension were signifi-cantly decreased(P＜0.05).There were no significant differences in extubation time,total and effective times of analgesic pump,rate of remedial analgesia,intraoperative hypotension,postoperative nausea,vom-iting,dizziness and respiratory depression between the two groups.Conclusion Remazolam has little effect on the secretion rhythm of melatonin and cortisol and the sleep rhythm after spinal surgery in elderly pa-tients,and the recovery is faster,which can reduce the incidence of POD and alleviate the sleep disorder af-ter spinal surgery.

Objective To investigate the correlation between baseline data,early treatment response and prognosis in children with acute lymphoblastic leukemia(ALL).Methods Ninety-two children with ALL were divided into the endpoint event group(19 cases)and the event-free survival group(73 cases)according to whether there was an endpoint event(recurrence or death).The age and gender at initial diagnosis were recorded.Initial white blood cell count(WBC),platelet count(PLT),immunophenotype,chromosome karyotype,fusion gene,prednisone test,bone marrow remission status on the 15th day of induction chemotherapy and minimal residual disease(MRD)on the 15th,33rd and 55th day of induction chemotherapy were detected.The correlation between the above baseline data and early treatment response and the occurrence of endpoint event in children with ALL was analyzed.Logistic regression was used to analyze influencing factors of endpoint events in children with ALL.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of baseline data and early treatment response to endpoint events in children with ALL.Results The proportion of WBC≥100×109/L at first diagnosis,prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy were higher in the endpoint event group than those in the event-free survival group(P<0.05),and there were no significance differences in remaining indicators(P>0.05).Logistic regression analysis showed that prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy were risk factors for endpoint event in children with ALL(P<0.05),and the combined value of the two indicators was better than that of a single indicator in predicting endpoint events in children with ALL.Conclusion Prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy are associated with recurrence and death in children with ALL.

Objective:To analyze the monitoring results of iodine deficiency disorders (IDD) in Hainan Province from 2011 to 2023, key prevention and control measures taken during this period, and the impact of related events on the monitoring results.Methods:From 2011 to 2023, a systematic sampling method was used to divide 21 cities (districts, counties) in Hainan Province into 5 districts based on east, west, south, north, and center each year. One township (street) was selected from each district, and 40 children aged 8 - 10 (non boarding students) and 20 pregnant women were selected from each township (street) for determination of iodine level of their household salt and urine samples. Based on the monitoring results, the impact of key events such as the pre reduction (2011), post reduction (implementation of new iodized salt standard, 2012 - 2023), salt industry system reform (2017), and the two-year campaign for endemic disease prevention and control (2019, 2000), on the salt iodine coverage rate and qualified iodized salt consumption rate, the urinary iodine level and its distribution in children and pregnant women were analyzed in Hainan Province. B-ultrasound was used to detect the situation of thyroid enlargement was analyzed.Results:(1) In 2011, the median iodine level in edible salt of residents in Hainan Province was 32.1 mg/kg. It was 30.8 mg/kg after the implementation of the new standard in 2012. In 2013, the salt iodine level of residents had significantly decreased to 25.9 mg/kg, with 24.5, 24.2, and 23.8 mg/kg in 2017, 2019, and 2020, respectively. The differences of median salt iodine levels between different years were statistically significant ( H = 29.01, P < 0.001). The coverage rate of iodized salt among residents in Hainan Province from 2011 to 2023 was 98.08% (80 727/82 308), and the difference between different years was statistically significant (χ 2 = 9.51, P = 0.023). The consumption rate of qualified iodized salt was 95.65% (78 738/82 308), and the difference between different years was statistically significant (χ 2 = 21.80, P < 0.001). (2) The median urinary iodine level of children from 2011 to 2023 was 177.5 μg/L, with a median of 204.2 μg/L in 2011. After the implementation of the new standard, the median urinary iodine level of children was 194.9 μg/L in 2012. In 2013, the median urinary iodine level in children decreased to 167.8 μg/L, and had remained within the range of 100 - < 200 μg/L thereafter. In 2017, 2019, and 2020, the median urinary iodine levels were 170.4, 172.8, and 186.3 μg/L, respectively. There was no statistically significant difference in different years ( H = 1.67, P = 0.061). The proportion of children with urinary iodine < 100 μg/L from 2011 to 2023 was 16.29% (8 740/53 634), and the proportion of children with urinary iodine between 100 and < 200 μg/L was 43.96% (23 575/53 634). The differences between different years were statistically significant (χ 2 = 21.50, 23.40, P < 0.001). The childhood goiter rate from 2011 to 2023 was 0.19% (101/53 634). (3) The median urinary iodine level of pregnant women was 153 μg/L in 2011, it was 154.7 μg/L in 2012 after the implementation of the new standard, and it had remained within the range of 100 - < 150 μg/L since then. The median urinary iodine level of pregnant women was 126.2 μg/L in 2013. The median urinary iodine level in 2017, 2019 and 2020 were 123.5, 133.8, and 135.4 μg/L, respectively. There was a statistically significant difference in the median urinary iodine levels of pregnant women between different years ( H = 92.10, P < 0.001). From 2011 to 2023, the proportion of pregnant women with a median urinary iodine level < 150 μg/L was the highest (55.75%, 14 761/26 477). Conclusion:From 2011 to 2023, although the monitoring results of iodine deficiency disorders in children and pregnant women in Hainan Province have fluctuated, they are still in a state of continuous elimination of IDD.