Objective: To investigate the role of butyric acid-producing bacteria in long bone homeostasis in mice with periodontitis under a high-fat/high-sugar diet and to provide new insights for the prevention and treatment of periodontitis and related bone metabolic diseases. Methods: This study has been approved by the Animal Welfare and Ethics Committee of the Experimental Animal Center. Initially, 14 mice were randomly divided into the CON group (the control group) and the LIG group (the periodontitis group). Mice in the LIG group had experimental periodontitis induced by ligating the second maxillary molars bilaterally and were fed a high-fat and high-sugar diet. After 8 weeks, samples were collected. Micro-computed tomography (Micro-CT) was used to analyze alveolar bone resorption and various parameters of the proximal tibia trabecular bone, including bone mineral density (BMD), bone volume per tissue volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp). After decalcification, hematoxylin and eosin (HE) staining was performed on maxillary bone sections to assess periodontal tissue inflammation and connective tissue destruction. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect related genes in the distal femur and proximal tibia bone tissues, including osteocalcin (OCN), osteogenic transcription factor (Osterix), osteoprotegerin (OPG), tartrate resistant acid phosphatase (TRAP), osteoclast-associated receptor (OSCAR), receptor activator of nuclear factor kappa-B (RANK), and receptor activator of nuclear factor kappa-B ligand (RANK-L). Subsequently, the other 28 mice were randomly divided into the CON group (the control group), LIG group (the periodontitis group), CON + butyric acid-producing bacteria (BP) group, and LIG + BP group. The breeding, sampling, and sample detection methods remained the same. Finally, the other 28 mice were randomly divided into the CON group (the control group), LIG group (the periodontitis group), CON + sodium butyrate (SB) group, and LIG + SB group. The breeding, sampling, and sample detection methods remained the same. Results: ①Periodontitis modeling was successful. Compared with the CON group, the LIG group exhibited significant alveolar bone resorption of the maxillary second molar, aggravated periodontal tissue inflammation, and connective tissue destruction. ②Periodontitis exacerbated long bone resorption in mice fed a high-fat high-sugar diet. Compared with the CON group, the LIG group had significantly lower BMD, BV/TV, Tb.N, and Tb.Th (P<0.05), and significantly higher Tb.Sp (P<0.05). HE staining of the proximal tibia showed that the trabeculae in the LIG group were sparse and disordered, with some areas showing fractures or dissolution. The expression of osteoblast markers (OCN, Osterix, OPG) was significantly lower in the LIG group (P<0.05), while the expression of the osteoclast marker TRAP showed an increasing trend (P>0.05). The ratio of RANK-L/OPG was significantly higher in the LIG group compared with the CON group (P<0.05). ③ Supplementation with butyric acid-producing bacteria alleviates periodontitis-induced disruption of long bone homeostasis in mice fed a high-fat/high-sugar diet. Compared with the LIG group, BMD and Tb.Th were significantly higher in the LIG + BP group. HE staining of the proximal tibia showed that bone resorption was mitigated in the LIG + BP group compared with the LIG group. The expression of OCN and Osterix was significantly higher in the LIG + BP group, while the expression of osteoclast-specific genes (OSCAR, RANK, RANK-L) was significantly lower (P<0.05). ④ Supplementation with butyrate alleviates periodontitis-induced disruption of long bone homeostasis in mice fed a high-fat/high-sugar diet. Compared with the LIG group, BV/TV and Tb.N were significantly higher in the LIG + SB group, and Tb.Sp was significantly lower (P<0.05). HE staining of the proximal tibia showed that bone resorption was mitigated in the LIG + SB group compared with the LIG group. The expression of Osterix, OPG, OSCAR, TRAP, and RANK was significantly lower in the LIG + SB group compared with the LIG group (P<0.05). Conclusion Periodontitis disrupts the long bone homeostasis of mice fed a high-fat high-sugar diet, aggravating long bone resorption. Supplementation with butyric acid-producing bacteria or butyrate can effectively alleviate the disruption of long bone homeostasis caused by periodontitis.

Objective:To investigate the expression of NOD-like receptor protein 3(NLRP3)inflammasome and its relation-ship with granulosa cell apoptosis in patients with polycystic ovary syndrome(PCOS).Methods:Follicular fluid and ovarian granulosa cells were collected from 17 PCOS patients(PCOS group)and 20 non-PCOS patients(control group),and the expression levels of pro-inflammatory factor,TNF-α,IL-1β and IL-18 in follicular fluid were detected by ELISA.RT-PCR and Western blot were used to de-tect NLRP3 mRNA and NLRP3 inflammasome associated protein NLRP3,ASC and cleaved caspase-1 and autophagy related protein LC3-Ⅱ/LC3-Ⅰ and p62 expression level in granulosa cells.TUNEL assay was used to detect the apoptotic level of granulosa cells in both groups.NLRP3 silenced siRNA(si-NLRP3)and negative control sequence(si-NC)were transfected into human ovarian cancer granulosa cell line KGN cells by siRNA interference technique in vitro.TNF-α was used to simulate PCOS-related cell damage.KGN cells were divided into 4 groups according to different treatment methods:Ctrl group,TNF-α group,TNF-α+si-NLRP3 group and TNF-α+si-NC group.The levels of DHEA,testosterone,IL-1β and IL-18 in supernatant were detected by ELISA.TUNEL assay was used to detect the apoptosis level of KGN cells.The LC3-Ⅱ/LC3-Ⅰ and p62,NLRP3,ASC and cleaved caspase-1 protein expression levels,and NF-κB p-p65 level(NF-κB p-p65/NF-κB p65)in KGN cells were detected by Western blot.Results:Compared with con-trol group,the concentration of TNF-α,IL-1β,and IL-18 in follicular fluid of PCOS patients,and LC3-Ⅱ/LC3-Ⅰ,NLRP3 mRNA and the protein expression of NLRP3,ASC,and cleaved caspase-1 in granulosa cells of and apoptosis were significantly increased(P<0.05 or P<0.01),while the protein expression of p62 was significantly decreased(P<0.01).Compared with Ctrl group,the levels of DHEA,testosterone,IL-1β and IL-18 in supernatant of TNF-α group,TNF-α+si-NC group,and TNF-α+si-NLRP3 group,and LC3-Ⅱ/LC3-Ⅰ,ASC and cleaved caspase-1 protein expression,and the level of NF-κB p-p65 and apoptosis were significantly increased(P<0.05 or P<0.01),while p62 protein was significantly decreased(P<0.01).NLRP3 was significantly decreased except in TNF-α+si-NLRP3 group(P<0.01),while in the TNF-α group and TNF-α+si-NC group was significantly increased(P<0.01).However,com-pared with TNF-α group,the above indexes in TNF-α+si-NLRP3 group were significantly decreased(P<0.05),and TNF-α+si-NC group had no significant change(P>0.05).Conclusion:The over-activated NLRP3 inflammasome in granulosa cells may promote cell inflammatory injury and autophagy apoptosis in PCOS patients through NF-κB pathway.

Objective:To systematically search and evaluate risk prediction models for ventilator-associated pneumonia (VAP) of ICU in order to provide references for developing higher-quality VAP risk prediction models.Methods:Relevant literature was retrieved from databases including China Biology Medicine disc, WanFang data, China National Knowledge Infrastructure, Embase, PubMed, CINAHL, Web of Science, and Cochrane Library. The search timeframe was from the establishment of the databases to September 30, 2023, limited to English and Chinese languages. Two researchers independently screened the literature and extracted data, and the PROBAST tool was used to evaluate the risk of bias and applicability of the included studies.Results:A total of 15 studies on VAP risk prediction models were included. The area under the receiver operating characteristic curve for the 15 models ranged from 0.722 to 0.982. The most frequently involved predictors were age, duration of mechanical ventilation, ICU length of stay, and comorbid chronic obstructive pulmonary disease. The overall adaptability was good, but the risk of bias was high. The main sources of bias included insufficient sample size, inappropriate data sources, lack of model performance evaluation, and inadequate attention to missing data.Conclusions:The risk of bias in studies on VAP risk prediction models is high, indicating that the field is still developing. Future research should focus on the effectiveness of different risk assessment methods to construct models with low bias, excellent predictive performance, and suitability for clinical practice in China.

Objective To analyze the relationship between fragmented QRS(fQRS)and microalbuminuria(MAU)and serum uric acid(SUA)in patients with type 2 diabetes mellitus(T2DM).Methods From October 2022 to June 2023,245 T2DM patients diagnosed by The Department of Endocrinology,Jinhua Hospital Affiliated to Zhejiang University School of Medicine were selected and divided into fQRS group(fQRS,n=111)and T2DM group(n=134)according to ECG results.The general data,biochemical indexes,left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),interventricular septum(IVS),left ventricular posterior wall(LVPW),left ventricular ejection fraction(LVEF),left atrial diameter(LAd),peak value ratio of mitral orifice blood flow velocity in early and late diastole(E/A)and mitral orifice blood flow velocity in early diastole were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between fQRS wave and other indexes in T2DM patients,and Logistic regression analysis was used to analyze the influencing factors of fQRS.Results The prevalence rates of UACR,SUA,HbA1c and MAU in fQRS group were higher than in T2DM group(P＜0.05 or P＜0.01).LVEDd,LAd,E,E/e'and E/A>1.5 in QRS group were higher than in T2DM group(P＜0.05 or P＜0.01).Pearson correlation analysis showed that fQRS wave was positively correlated with smoking history,BMI,HbA1c,UACR,MAU,SUA,LVEDd,LAd,E/A and E/e'(P＜0.05).Logistic regression analysis showed that MAU was the influencing factor of fQRS wave in T2DM patients.Conclusions The fQRS in ECG in patients with T2DM is associated with MAU and SUA and may be an important evidence of myocardial fibrosis associated with subclinical cardiac diastolic dysfunction.

Objective:To explore the latent profile of discharge readiness of patients with lower extremity arteriosclerosis obliterans and analyze its influencing factors, so as to provide theoretical basis for individualized management of discharge readiness in patients with lower limb arteriosclerosis obliterans.Methods:From February 2022 to December 2022, 194 patients with arteriosclerosis obliterans of lower limbs who received surgical treatment in the vascular surgery department of Shandong Provincial Hospital Affiliated to Shandong First Medical University were investigated by using general information questionnaire, Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale and Family APGAR Index for a cross-sectional survey. Latent profile analysis was used to identify different categories, and Logistic regression analysis was used to explore its influencing factors.Results:Totally 182 valid questionnaires were collected, of which 127 males and 55 females, and patients over 60 years old were the majority, accounting for 81.9%. Three latent profile models were identified in this study, namely, low discharge readiness group (27.47%), medium discharge readiness-high expected support group (41.21%) and high discharge readiness group (31.31%). Logistic regression analysis showed that first hospitalization ( OR=19.218, 95% CI 2.949-125.237), the quality of discharge guidance ( OR=0.896, 95% CI 0.857-0.937) were the predictive factors of medium discharge readiness-high expected support group ( P<0.05); family function ( OR=0.185, 95% CI 0.097-0.353) and the quality of discharge guidance ( OR=0.823, 95% CI 0.764-0.888) were the predictive factors of the low discharge readiness group of patients with arteriosclerosis obliterans (all P<0.05). Conclusions:There are different types of discharge readiness of patients with arteriosclerosis obliterans, and patients with poor quality of discharge guidance and poor family function are more likely to have a trend of low discharge readiness. Patients with low quality discharge guidance and first hospitalization are more likely to have a trend of moderate discharge readiness-high expected support. For this kind of patients, medical staff should take corresponding measures to improve their readiness for discharge.

The upset insomnia caused by life and work pressure has seriously affected the physical and mental health of modern people and induced many diseases. The quality of Chinese medicine for nourishing heart and tranquilizing mind is stable, and it has a significant effect on the treatment of insomnia, with fewer adverse reactions, and no dependence on sedative and hypnotic as chemical drugs. The Chinese herbal pieces and preparations for nourishing heart and tranquilizing mind can be divided into psychotropic and sedative drugs according to their functions. Their active ingredients mainly include flavonoids, alkaloids, organic acids, polysaccharides, amino acids and vitamins, etc. They are mostly used in the treatment of cardiovascular diseases and central nervous system inhibition. In this paper, the types and active ingredients and development tendency and application status of the Chinese herbal pieces and preparations of nourishing heart and tranquilizing mind were reviewed individually, in order to provide reference for the development of drugs of nourishing heart and tranquilizing mind in the field of clinical application and related drugs.

Objective To investigate the relationship and potential pathways between metal(loid)exposure and the risk of polycystic ovary syndrome(PCOS)in women of childbearing age. Methods This case-control study included 200 patients with PCOS(cases)and 896 non-PCOS controls with the age of 25-37 years.The concentrations of 29 metal(loid)s in the follicular fluid(FF)and clinical indicators in the serum were measured in all participants.Logistic regression analysis and mediation analysis were conducted to evaluate the associations between metal(loid)exposure and PCOS risk and investigate the possible roles of clinical indicators,respectively. Results Logistic regression analysis revealed an association between high copper levels in FF and increased PCOS risk(highest vs.lowest quartile:adjusted odds ratio=2.94,95%confidence interval:1.83-4.72).A high luteinizing hormone/follicle-stimulating hormone ratio and elevated levels of testosterone and anti-Müllerian hormone(AMH)were strongly associated with increased PCOS risk induced by high copper exposure.The mediation analysis indicated a mediating effect of AMH in the association between copper exposure and PCOS risk. Conclusion Copper may affect PCOS risk through the hypothalamic-pituitary-ovarian axis,mediated by AMH.Copper exposure and internal AMH levels are important indicators for early warning of PCOS development.

Periodontitis is a chronic inflammatory disease characterized by progressive destruction of alveolar bone.The most critical mechanism underlying alveolar bone destruction is the imbalance of bone homeostasis,where osteoblast-mediated bone matrix synthesis plays an important role in regulating bone homeostasis.Regulated cell death is instrumental in both the inflammatory microenvironment and the regulation of bone homeostasis.Chronic inflammation,oxidative stress,and other factors can be directly involved in mitochondrial and death receptor-mediated signaling pathways,modulating B-cell lymphoma 2 family proteins and cysteine aspartic acid specific protease(caspase)activity,thereby affecting osteoblast apoptosis and alveolar bone homeostasis.Chronic inflammation and cellular damage induce osteoblast necroptosis via the RIPK1/RIPK3/MLKL signaling pathway,exacerbating the inflammatory response and accelerating alveolar bone destruction.Stimuli such as pathogenic microorganisms and cellular injury may also activate caspase-1-dependent or independent signaling pathways and gasdermin D family proteins,promoting osteoblast pyroptosis and releasing pro-inflammatory cytokines to mediate alveolar bone damage.Iron overload and lipid peroxidation in periodontitis can trigger ferroptosis in osteoblasts,impacting their survival and function,ultimately leading to bone homeostasis imbalance.This article focuses on the mechanism of periodontal disease affecting bone homeostasis through regulatory cell death,aiming to provide research evidence for the treatment of periodontitis and alveolar bone homeostasis imbalance.

Objective:To explore the application of artificial intelligence (AI) assistant system combined with case-based learning (CBL) in the teaching of strabismus specialty for ophthalmic residents.Methods:Forty ophthalmic residents who were trained in the Department of Ophthalmology of the People's Hospital of Peking University from January 2020 to December 2021 were divided into control group and experimental group, with 20 people in each group. The control group used the traditional teaching mode, and the experimental group used AI assistant system combined with CBL teaching. At the end of specialized training, the two groups were assessed for theoretical knowledge, clinical skills, clinical thinking and questionnaire survey, and the teaching effect was evaluated. SPSS 26.0 was used for Chi-square test, one-way ANOVA and independent-samples t-test. Results:The scores of theoretical knowledge [(34.10±1.33) points], clinical skills [(24.75±1.02) points] and clinical thinking [(24.80±0.77) points] in the experimental group were significantly higher than those in the control group [(33.15±1.35) points, t=2.24, P=0.031; (23.60±0.82) points, t=3.93, P<0.001; (24.20±0.83) points, t=2.37, P=0.023]. For the evaluation of teaching effect, the experimental group improved the learning interest ( t=11.47, P<0.001), clinical thinking ability ( t=9.36, P<0.001), knowledge and skill level ( t = 17.71, P < 0.001), knowledge sharing ( t=31.17, P< 0.001) and overall satisfaction ( t=10.60, P<0.001), and these 5 aspects were scored higher in experimental group compared with the control group. Conclusion:The teaching mode combining AI assistant system and CBL teaching can improve the independent diagnosis and treatment ability of ophthalmic residents for strabismus diseases, establish a correct clinical thinking path, and obtain a better teaching effect than the traditional teaching mode.

Objective:To explore any effect of following an individualized exercise program on the cardio-pulmonary health of elderly persons with stable chronic obstructive pulmonary disease (COPD).Methods:A total of 120 elderly COPD patients were randomly divided into an experimental group and a control group, each of 60. Both groups were given medication and routine rehabilitation treatment for 3 months, but the experimental group also followed an individualized exercise program based on the cardiopulmonary exercise test. Before and after the treatment, Borg scoring was used to assess the subjects′ degree of dyspnea. Forced expiratory volume (FEV 1), forced vital capacity (FVC), maximum oxygen uptake (VO 2max), anaerobic threshold (AT), heart rate (HR) and a heart index (CI) were also recorded. The 6-minute walk test (6 MWD) was administered to evaluate the rehabilitation effect. Results:There were no significant differences in the average Borg scores, cardiopulmonary function indexes or 6MWD distances between the two groups before treatment. After the treatment significant improvement was observed in all of the measurements in both groups, but at that point all of the experimental group′s averages were better than those of the control group.Conclusion:Individualized exercise based on the cardiopulmonary exercise test can alleviate the symptoms of dyspnea in elderly COPD patients, improve their cardiopulmonary functioning and exercise endurance and improve the rehabilitation effect.