Objective To investigate the factors influencing hyperdynamic circulation-related indicators in patients with liver cirrhosis and ascites.Methods A retrospective analysis was conducted on the clinical data of 377 patients diagnosed with cirrhosis-associated ascites at the Third People's Hospital of Kunming between October 2022 and October 2024.Patients were categorized into grade 1,grade 2,and grade 3 ascites groups according to ascites severity grading.The general demographic characteristics and clinical parameters of the three groups were compared.Potential positive predictors were initially identified through univariate analyses,including Spearman correlation and non-parametric tests.Binary logistic regression and multiple linear regression models were subsequently employed to investigate the factors influencing high dynamic circulation-related indicators(heart rate[HR],E/A ratio,and left ventricular diastolic function[LVDF])in patients with cirrhosis-related ascites.Results Significant differences in the incidence of HR,the ratio of early to late diastolic filling velocities(E/A),and LVDF were observed among different ascites groups(P<0.05).Age,ascites depth,serum chloride(Cl-),CO2,red cell distribution width coefficient of variation(RDW-CV),and etiology were identified as independent determinants of HR in patients with liver cirrhosis and ascites.Age,white blood cell count(WBC),albumin(ALB),and etiology were independent determinants of E/A in patients with liver cirrhosis and ascites.Age(OR=1.088,95%CI 1.062-1.114,P<0.001)and serum potassium(K+)(OR=1.919,95%CI 1.218-3.025,P=0.005)were independent risk factors for LVDF in patients with cirrhotic ascites,whereas RDW-CV(OR=0.902,95%CI 0.883-0.961,P=0.023)and ALB(OR=0.921,95%CI 0.883-0.961,P<0.001)were identified as protective factors.Conclusions Serum ALB is an independent influencing factor for E/A ratio and LVDF in cirrhotic patients with ascites and hyperdynamic circulation.K+and RDW-CV are also independent predictors of LVDF,whereas Cl-independently influences heart rate.Clinical monitoring and targeted intervention for these parameters should be emphasized.

Objective To investigate the factors influencing hyperdynamic circulation-related indicators in patients with liver cirrhosis and ascites.Methods A retrospective analysis was conducted on the clinical data of 377 patients diagnosed with cirrhosis-associated ascites at the Third People's Hospital of Kunming between October 2022 and October 2024.Patients were categorized into grade 1,grade 2,and grade 3 ascites groups according to ascites severity grading.The general demographic characteristics and clinical parameters of the three groups were compared.Potential positive predictors were initially identified through univariate analyses,including Spearman correlation and non-parametric tests.Binary logistic regression and multiple linear regression models were subsequently employed to investigate the factors influencing high dynamic circulation-related indicators(heart rate[HR],E/A ratio,and left ventricular diastolic function[LVDF])in patients with cirrhosis-related ascites.Results Significant differences in the incidence of HR,the ratio of early to late diastolic filling velocities(E/A),and LVDF were observed among different ascites groups(P<0.05).Age,ascites depth,serum chloride(Cl-),CO2,red cell distribution width coefficient of variation(RDW-CV),and etiology were identified as independent determinants of HR in patients with liver cirrhosis and ascites.Age,white blood cell count(WBC),albumin(ALB),and etiology were independent determinants of E/A in patients with liver cirrhosis and ascites.Age(OR=1.088,95%CI 1.062-1.114,P<0.001)and serum potassium(K+)(OR=1.919,95%CI 1.218-3.025,P=0.005)were independent risk factors for LVDF in patients with cirrhotic ascites,whereas RDW-CV(OR=0.902,95%CI 0.883-0.961,P=0.023)and ALB(OR=0.921,95%CI 0.883-0.961,P<0.001)were identified as protective factors.Conclusions Serum ALB is an independent influencing factor for E/A ratio and LVDF in cirrhotic patients with ascites and hyperdynamic circulation.K+and RDW-CV are also independent predictors of LVDF,whereas Cl-independently influences heart rate.Clinical monitoring and targeted intervention for these parameters should be emphasized.

Objective To explore the relationship between corrected QT interval(QTc)and short-term mortality rate in patients with cirrhotic ascites and the predictive value of QTc combined with Child-Pugh class for short-term death.Methods Patients hospitalized with cirrhotic ascites from October 2022 to March 2024 were selected as study subjects(training set,n=245),and similar patients from April to October 2024 were included for external validation(validation set,n=88).Patients'demographic data,basic clinical data,and first electrocardiography related indicators on admission were collected.Patients were divided into a death group and a survival group according to the 30-day follow-up result.The influencing factors for prognosis were explored by Lasso regression and univariate and multivariate binary logistic regression.A death risk nomogram model was constructed and evaluated by receiver operating characteristic curve(ROC curve),calibration curve,and decision curve.Data were analyzed for normality using Shapiro-Wilk test.Pairwise comparison for continuous data that were normally distributed was conducted by the independent-samples t test.Pairwise comparison for continuous data that were not normally distributed was conducted by the Mann-Whitney U test.Pairwise comparison for categorical data was performed using the chi-square test.Results The mortality rates were 35.1%(86/245)in the training set and 30.7%(27/88)in the validation set.Lasso regression showed that combined tumor,QTc,hematocrit,total bilirubin(TBil),direct bilirubin,alkaline phosphatase,albumin,cholinesterase,high-density lipoprotein cholesterol,carcinoembryonic antigen,international normalized ratio,model for end-stage liver disease(MELD),and Child-Pugh class were potential influencing factors for 30-day death in patients with cirrhotic ascites.Univariate and multivariate logistic regression showed that QTc(odds ratio[OR]=1.010,95%confidence interval[CI]:1.001-1.020,P=0.039),presence of tumor(OR=6.904,95%CI:2.997-12.391,P<0.001),TBil(OR=1.009,95%CI:1.004-1.014,P=0.001),and Child-Pugh class(OR=2.532,95%CI:1.256-5.105,P=0.009)were independent risk factors for 30-day death in patients with cirrhotic ascites.For the nomogram model constructed based on the results of the multivariate logistic analysis,the area under the ROC curve in the training set was 0.824;the sensitivity and specificity were 81.1%and 74.4%,respectively;the Hosmer-Lemeshow goodness-of-fit test showed P=0.673;the mean absolute error of the calibration curve was 0.020.The area under the ROC curve in the validation set was 0.886;the sensitivity and specificity were 91.8%and 70.4%,respectively;the Hosmer-Lemeshow goodness-of-fit test showed P=0.965;the mean absolute error of the calibration curve was 0.032.With the threshold probability of 0.15 to 0.85,the decision curve suggested a good benefit.The area under the ROC curve of the predictive model(0.824)was greater than conventional MELD score(0.700),MELD-Na score(0.698),and Child-Pugh score(0.674)(all P<0.05).Conclusion QTc is an independent predictor of short-term death in patients with cirrhotic ascites,and the prognostic model including QTc and Child-Pugh class has a good predictive value for short-term mortality rate.

Objective:To evaluate the efficacy of intraoperative sliding CT assisted deep brain stimulation of subthalaminal nucleus (STN-DBS) in short-term motor improvement and its influencing factors in patients with Parkinson's disease (PD) under general anesthesia.Methods:The cohort consisted of 48 PD patients accepted STN-DBS in Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University from June 2021 to June 2023, including 21 patients accepted STN-DBS under general anesthesia and 27 patients accepted STN-DBS under local anesthesia. STN-DBS was performed in the CT operating room and intraoperative CT was used to confirm the electrode position. Regular program-controlled follow-up for over one year in Out-patient Clinic was applied after discharge. Operation time, complications, stimulus-related adverse events, unified Parkinson's disease rating scale (UPDRS)-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-off (Med-off) stage/DBS-on stage 1 year after operation, and UPDRS-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-on (Med-on) stage/DBS-on stage 1 year after operation, and levodopa equivalent daily dose (LEDD) and LEDD reduction were compared between the two groups. Spearman rank correlation analysis or Pearson correlation analysis were used to investigate the correlation between short-term motor improvement ([UPDRS-Ⅲ score at Med-off stage before operation-UPDRS-Ⅲ score at Med-off stage/DBS-on stage 1 year after operation]/UPDRS-Ⅲ score at Med-off stage before operation×100%) and clinical data in PD after STN-DBS under general anesthesia.Results:The operation time of general anesthesia group was (1.9±0.5) h, and that of local anesthesia group was (2.6±0.8) h, with significant difference ( P<0.05). During the 1-year follow-up, no significant difference in incidence of adverse reactions, UPDRS-Ⅲ score improvement rate at Med-on and Med-off stages, LEDD and LEDD reduction was noted between the two groups ( P>0.05). In the general anesthesia group, the short-term motor improvement after STN-DBS was negatively correlated with age or gender ( P>0.05), but positively correlated with maximum improvement rate of preoperative UPDRS-Ⅲ score ( r=0.840, P<0.001). Conclusion:For patients who cannot tolerate local anesthesia, DBS under general anesthesia is also safe and effective.

Objective To explore the relationship between corrected QT interval(QTc)and short-term mortality rate in patients with cirrhotic ascites and the predictive value of QTc combined with Child-Pugh class for short-term death.Methods Patients hospitalized with cirrhotic ascites from October 2022 to March 2024 were selected as study subjects(training set,n=245),and similar patients from April to October 2024 were included for external validation(validation set,n=88).Patients'demographic data,basic clinical data,and first electrocardiography related indicators on admission were collected.Patients were divided into a death group and a survival group according to the 30-day follow-up result.The influencing factors for prognosis were explored by Lasso regression and univariate and multivariate binary logistic regression.A death risk nomogram model was constructed and evaluated by receiver operating characteristic curve(ROC curve),calibration curve,and decision curve.Data were analyzed for normality using Shapiro-Wilk test.Pairwise comparison for continuous data that were normally distributed was conducted by the independent-samples t test.Pairwise comparison for continuous data that were not normally distributed was conducted by the Mann-Whitney U test.Pairwise comparison for categorical data was performed using the chi-square test.Results The mortality rates were 35.1%(86/245)in the training set and 30.7%(27/88)in the validation set.Lasso regression showed that combined tumor,QTc,hematocrit,total bilirubin(TBil),direct bilirubin,alkaline phosphatase,albumin,cholinesterase,high-density lipoprotein cholesterol,carcinoembryonic antigen,international normalized ratio,model for end-stage liver disease(MELD),and Child-Pugh class were potential influencing factors for 30-day death in patients with cirrhotic ascites.Univariate and multivariate logistic regression showed that QTc(odds ratio[OR]=1.010,95%confidence interval[CI]:1.001-1.020,P=0.039),presence of tumor(OR=6.904,95%CI:2.997-12.391,P<0.001),TBil(OR=1.009,95%CI:1.004-1.014,P=0.001),and Child-Pugh class(OR=2.532,95%CI:1.256-5.105,P=0.009)were independent risk factors for 30-day death in patients with cirrhotic ascites.For the nomogram model constructed based on the results of the multivariate logistic analysis,the area under the ROC curve in the training set was 0.824;the sensitivity and specificity were 81.1%and 74.4%,respectively;the Hosmer-Lemeshow goodness-of-fit test showed P=0.673;the mean absolute error of the calibration curve was 0.020.The area under the ROC curve in the validation set was 0.886;the sensitivity and specificity were 91.8%and 70.4%,respectively;the Hosmer-Lemeshow goodness-of-fit test showed P=0.965;the mean absolute error of the calibration curve was 0.032.With the threshold probability of 0.15 to 0.85,the decision curve suggested a good benefit.The area under the ROC curve of the predictive model(0.824)was greater than conventional MELD score(0.700),MELD-Na score(0.698),and Child-Pugh score(0.674)(all P<0.05).Conclusion QTc is an independent predictor of short-term death in patients with cirrhotic ascites,and the prognostic model including QTc and Child-Pugh class has a good predictive value for short-term mortality rate.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

The efficacy of root canal therapy, as a core intervention for endodontic and periapical diseases, is highly dependent on the effectiveness of antimicrobial drugs. Although traditional drugs such as calcium hydroxide, chlorhexidine, and antibiotic pastes commonly used in the clinic play a role in preventing and controlling infections, they have obvious limitations. These drugs influence the mechanical properties of dentin, insufficiently solubilize necrotic tissues, and are susceptible to bacterial resistance, which makes achieving the desired effectiveness and safety difficult. Traditional macromolecular root canal drugs also face the challenge of the complexity of the root canal system. With the rapid development of material science in recent years, new antimicrobial agents have emerged. Metallic nanomaterials such as silver nanoparticles and zinc oxide nanoparticles are widely used in the medical field due to their unique physicochemical properties and superior antimicrobial properties. Chitosan nanoparticles have superior biosafety, calcium hydroxide nanoparticles compensate for the limitations of traditional calcium hydroxide formulations, and quaternary ammonium polyethyleneimine nanoparticles can confer antimicrobial properties to existing oral materials. Novel antimicrobial nanoparticles using nano-delivery systems, such as mesoporous calcium silicate and mesoporous silica, carry antimicrobial molecules with significant advantages in terms of anti-biofilm, biosafety, and promotion of tissue repair. Further, these agents reduce drug resistance, which improves prospects for application compared to traditional root canal disinfection drugs. The breakthrough of nanotechnology provides a novel direction for the innovation of root canal treatment drugs. Therefore, this paper reviews the research progress of nano-antimicrobial materials in root canal therapy.

Objective:To evaluate the efficacy of intraoperative sliding CT assisted deep brain stimulation of subthalaminal nucleus (STN-DBS) in short-term motor improvement and its influencing factors in patients with Parkinson's disease (PD) under general anesthesia.Methods:The cohort consisted of 48 PD patients accepted STN-DBS in Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University from June 2021 to June 2023, including 21 patients accepted STN-DBS under general anesthesia and 27 patients accepted STN-DBS under local anesthesia. STN-DBS was performed in the CT operating room and intraoperative CT was used to confirm the electrode position. Regular program-controlled follow-up for over one year in Out-patient Clinic was applied after discharge. Operation time, complications, stimulus-related adverse events, unified Parkinson's disease rating scale (UPDRS)-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-off (Med-off) stage/DBS-on stage 1 year after operation, and UPDRS-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-on (Med-on) stage/DBS-on stage 1 year after operation, and levodopa equivalent daily dose (LEDD) and LEDD reduction were compared between the two groups. Spearman rank correlation analysis or Pearson correlation analysis were used to investigate the correlation between short-term motor improvement ([UPDRS-Ⅲ score at Med-off stage before operation-UPDRS-Ⅲ score at Med-off stage/DBS-on stage 1 year after operation]/UPDRS-Ⅲ score at Med-off stage before operation×100%) and clinical data in PD after STN-DBS under general anesthesia.Results:The operation time of general anesthesia group was (1.9±0.5) h, and that of local anesthesia group was (2.6±0.8) h, with significant difference ( P<0.05). During the 1-year follow-up, no significant difference in incidence of adverse reactions, UPDRS-Ⅲ score improvement rate at Med-on and Med-off stages, LEDD and LEDD reduction was noted between the two groups ( P>0.05). In the general anesthesia group, the short-term motor improvement after STN-DBS was negatively correlated with age or gender ( P>0.05), but positively correlated with maximum improvement rate of preoperative UPDRS-Ⅲ score ( r=0.840, P<0.001). Conclusion:For patients who cannot tolerate local anesthesia, DBS under general anesthesia is also safe and effective.

Objective:To investigate the distribution characteristics and analyze the clinical significance of dermatophagoides pteronyssinus allergen components in children with allergic rhinitis and asthma in Shenzhen.Methods:This study was a cross-sectional study. The clinical data of children with allergic rhinitis and asthma induced by dust mites admitted to the allergy clinic of Shenzhen Children′s Hospital from 2021 to 2024 were collected and the serum sIgE levels of dermatophagoides pteronyssinus, dermatophagoides farinae (Der p, Der f) and dermatophagoides pteronyssinus components (Der p 1, Der p 2, Der p 10, Der p 23) were detected by magnetic bead chemiluminescence method. The correlation between dermatophagoides pteronyssinus allergen components and clinical data of children was analyzed. According to the diagnosis, the children were divided into allergic rhinitis (AR) group and AR with asthma (ARAS) group. According to the age, the children were divided into preschool age (5 years ≤age<7 years), school age (7 years ≤age<10 years) and adolescence (10 years ≤age≤15 years). The expression differences of dermatophagoides pteronyssinus components among AR group and ARAS group and different age groups were compared.Results:A total of 314 children with allergic rhinitis and asthma caused by dust mites were included in the study, of whom 112 were male and 202 were female. There were 188 cases of AR and 126 cases of ARAS, aged 5-15 years, with a median age of 7.54 years and an average age of (8.02±2.24) years. BMI was 13.89-31.76 kg/m 2,the median BMI was 15.87 kg/m2 and average BMI was (16.55±3.05) kg/m2. There was not statistically significant difference in gender, age, BMI, blood eosinophils, blood basophils, FeNO, FVC and FEV1 between the AR group and the ARAS group ( P>0.05). There was significant difference in FEV1/FVC and small airway function indexes MMEF, MEF75%, MEF50% and MEF25% between the AR group and the ARAS group ( P<0.05). In the 314 children, the dermatophagoides pteronyssinus allergen components sensitization rates were in the order of Der p 1 (97.1%), Der p 2 (89.8%), Der p 23 (55.1%), Der p 10 (8.6%), and the difference in the positive rate was statistically significant (χ 2=658.31, P<0.001). There was not significant difference in Der p 1, Der p 2 and Der p 10 among children of different ages ( P>0.05). There was significant difference in Der p 23 among children of different ages (χ 2=7.29, P=0.03). A correlation analysis showed that Der p, Der f, Der p 1 and Der p 2 had a high positive correlation ( P<0.001). Eosinophils are positively correlated with Der p, Der f, Der p 1, Der p 2, Der p 10 and Der p 23 ( P<0.001). FeNO is positively correlated with Der p, Der f, and Der p 23 ( P<0.05). Small airway function indicators MMEF, MEF50% and MEF25% are negatively correlated with Der p, Der f and Der p 1 ( P<0.05). The sIgE levels of Der p, Der f, Der p 1, Der p 2 and Der p 10 in the AR group were significantly lower than those in the ARAS group ( P<0.05). In the ARAS group, 120 cases (95.24%) showed positive results for at least 2 dermatophagoides pteronyssinus components, while 71 cases (56.35%) showed positive results for at least 3 dermatophagoides pteronyssinus components. In the AR group, 171 cases (90.96%) showed positive results for at least 2 dermatophagoides pteronyssinus components, while 94 cases (50.00%) showed positive results for at least 3 dermatophagoides pteronyssinus components. Conclusion:Der p 1, Der p 2 and Der p 23 may be the main dermatophagoides pteronyssinus allergen components that induce allergic rhinitis and asthma in Shenzhen City. The elevation of sIgE levels in the dermatophagoides pteronyssinus components can aggravate the severity of lower airway eosinophilic inflammation and airway obstruction. Attention should be paid to the detection of dermatophagoides pteronyssinus components in children with poor response to dust mite-allergen specific immunotherapy.

The standardized workflow of computer-aided static guided implant surgery includes preoperative exami-nation,data acquisition,guide design,guide fabrication and surgery.Errors may occur at each step,leading to irrevers-ible cumulative effects and thus impacting the accuracy of implant placement.However,clinicians tend to focus on fac-tors causing errors in surgical operations,ignoring the possibility of irreversible errors in nonstandard guided surgery.Based on the clinical practice of domestic experts and research progress at home and abroad,this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection,data collection,guide de-signing and manufacturing and describes strategies to resolve errors so as to gain expert consensus.Consensus recom-mendation:1.Preoperative considerations:the appropriate implant guide type should be selected according to the pa-tient's oral condition before surgery,and a retaining screw-assisted support guide should be selected if necessary.2.Da-ta acquisition should be standardized as much as possible,including beam CT and extraoral scanning.CBCT performed with the patient's head fixed and with a small field of view is recommended.For patients with metal prostheses inside the mouth,a registration marker guide should be used,and the ambient temperature and light of the external oral scan-ner should be reasonably controlled.3.Optimization of computer-aided design:it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers.Properly designing the retaining screws,extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors.4.Improving computer-aided production:it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postpro-cessing procedures.