Objective To explore the causal relationship between immune cells and heart failure (HF), and the mediating role of serum metabolites, in order to identify potential biomarkers and therapeutic targets. Methods We employed a two-sample Mendelian randomization (MR) analysis method based on genome-wide association study (GWAS) data, analyzing the direct and indirect effects of 731 types of immune cells and 1 400 metabolites on HF. We selected valid instrumental variables and conducted statistical analyses using R software. The primary analysis was performed using the inverse variance weighted method, supplemented by MR-Egger analysis and weighted median method. The stability of the results was assessed through tests such as Cochran’s Q test. Results Our research found a negative causal relationship between PD-L1 on CD14−CD16+ and HF. Sensitivity analysis supported this result. The reverse MR analysis did not find an effect of HF on PD-L1 on CD14−CD16+, indicating that PD-L1 on CD14−CD16+ might play a unidirectional role in reducing the risk of HF. Further mediation MR analysis showed that PD-L1 on CD14−CD16+ might influence the risk of HF onset by regulating the levels of sphingomyelin (d17:1/14:0, d16:1/15:0), with a mediation effect ratio of 6.7%. Conclusion PD-L1 on CD14−CD16+ may reduce the risk of HF by elevating the levels of sphingomyelin (d17:1/14:0, d16:1/15:0), which provides a new perspective for understanding the pathogenesis of HF.

AIM: To observe the changes of corneal densitometry(CD)and higher-order aberrations after small incision lenticule extraction(SMILE), and to explore their correlations and influencing factors.METHODS: Prospective study. A total of 62 high-degree myopia and compound myopic astigmatism patients(62 eyes)who underwent SMILE in Urumqi Aier Eye Hospital from December 2022 to November 2023 were collected. The CD, root mean square of corneal higher-order aberrations(RMS HOA), spherical aberration, vertical coma, horizontal coma, and corneal epithelial thickness(CET)of the patients were measured before surgery, and at 1 d, 1 wk, 1, 3, and 6 mo after surgery, respectively.RESULTS:There were 4 patients lost to follow-up during the period, all due to failure to attend scheduled reexaminations. The number of complete and valid cases was 58 eyes. The CD in the central and paracentral regions of the anterior, middle, and total layer of the cornea increased significantly on the first day after surgery(all P<0.003). At 6 mo after surgery, there was a slight but statistically significant decrease in the CD of the central and paracentral regions of the anterior and the total anterior layer(all P<0.003). Compared with the preoperative baseline values, the RMS HOA, spherical aberration, and vertical coma significantly increased at 6 mo after surgery(all P<0.003), while the change in horizontal coma was not statistically significant. Compared with the preoperative baseline values, the CET in the central, paracentral, and peripheral regions of the cornea, as well as the total average CET in the 0-7 mm range of the cornea increased at 6 mo after surgery(all P<0.003). At 1 d after surgery, CD of the anterior layer and total layer in the central region of the cornea were positively correlated with the CET in the central region(rs=0.327, rs=0.250, all P<0.05). At 6 mo after the surgery, the CD of the middle layer and posterior layer in the central corneal region were negatively correlated with the preoperative spherical equivalent and the change of RMS HOA(all P<0.05).CONCLUSION:The anterior CD decreases at 6 mo after SMILE for high myopia correction, and there is a certain correlation between the changes in CD and some clinical parameters.

With the growing emphasis on maternal and child oral health, the significance of managing oral health across preconception, pregnancy, and infancy stages has become increasingly apparent. Oral health challenges extend beyond affecting maternal well-being, exerting profound influences on fetal and neonatal oral development as well as immune system maturation. This expert consensus paper, developed using a modified Delphi method, reviews current research and provides recommendations on maternal and child oral health management. It underscores the critical role of comprehensive oral assessments prior to conception, diligent oral health management throughout pregnancy, and meticulous oral hygiene practices during infancy. Effective strategies should be seamlessly integrated across the life course, encompassing preconception oral assessments, systematic dental care during pregnancy, and routine infant oral hygiene. Collaborative efforts among pediatric dentists, maternal and child health workers, and obstetricians are crucial to improving outcomes and fostering clinical research, contributing to evidence-based health management strategies.
Humans ; Pregnancy ; Female ; Infant ; Consensus ; Mouth Diseases/therapy* ; Pregnancy Complications/therapy* ; Oral Health ; Infant, Newborn ; Delphi Technique ; Oral Hygiene

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To investigate the impact of deep learning image reconstruction (DLIR), adaptive statistical iterative reconstruction-veo (ASiR-V) and filtered back projection (FBP) on the histogram and wavelet features of portal venous phase abdominal CT in patients with hepatic tumor.Methods:The CT data of 68 patients with hepatic tumor who underwent enhanced CT scans were retrospectively collected. FBP, 30%ASiR-V, DLIR-L, DLIR-M and DLIR-H images were reconstructed. The images of portal venous phase were reconstructed with five algorithms, including FBP, ASIR-V at a level of 30% (ASiR-V 30%), DLIR at low (DLIR-L), medium (DLIR-M), and high (DLIR-H). Histogram and wavelet features were extracted from hepatic lesion, liver, spleen, kidney and erector spinae muscle, and compared using one-way analysis of variance or Kruskal-Wallis test. Two radiologists delineated the three-dimensional lesions independently and one of them repeated the delineation after one month. Intra-class correlation coefficients ( ICC) among five sets of images were calculated to evaluate the consistency of radiomics features of hepatic lesion. P<0.05 was considered to indicate statistical significance. Results:Most histogram and wavelet features extracted from hepatic lesion, liver, spleen, kidney and erector spinae muscle showed significant differences among five groups (all P<0.05). The number of features without significant differences decreased with the intensity of DLIR reconstruction increased. For histogram features, there were no significant differences of energy, mean, median, and total energy among five sets of images ( P>0.05). For wavelet features, there were no significant differences of mean and median among five sets of images ( P>0.05). The consistency of all histogram features was high except for the mean value of wavelet feature. The intra-and inter-observer ICC ranged from 0.756 to 1 and 0.767 to 1, respectively. Conclusion:Both 30%ASiR-V and DLIR at three levels algorithms had influence on the histogram and wavelet features of abdominal organs and hepatic tumors extracted from CT images in portal venous phase, and the effects expanded with the strengthening of levels. Median can be a reliable quantitative parameter for CT texture analysis of hepatic tumor.

BACKGROUND: Urolithiasis is a widespread disease with a high prevalence worldwide. This study aims to evaluate the disease burden of urolithiasis and its trends from 1990 to 2021 globally, based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. METHODS: The numbers and age-standardized rates (ASRs) of incidence, disability-adjusted life years (DALYs), and mortality of urolithiasis were extracted from GBD 2021 to represent the disease burden. Joinpoint regression analyses were conducted to assess the temporal trends in the burden of urolithiasis. The male-to-female ASR ratio indices were used to evaluate sex disparities. Additionally, we explored the relationship between the ASR ratio and the sociodemographic index (SDI). RESULTS: The total numbers of incidence, DALY, and mortality of urolithiasis were 105,983,780 cases (95% uncertainty interval [UI] = 88,349,356-128,645,155 cases), 693,444 cases (95% UI = 567,765-850,490 cases), and 17,672 cases (95% UI = 13,932-21,241 cases), respectively, in 2021. There is an increasing trend in the number of these measures globally, whereas the ASRs have decreased over the past 30 years. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were significantly higher in males than in females in 2021. The sex disparities in the age-standardized DALY rate (ASDR) and ASMR of urolithiasis were negatively correlated with the SDI. In 2021, the ASIR of urolithiasis was 964.70 (95% UI = 801.26-1175.09) per 100,000 people in China, which is much lower than the global average (1242.84 [95% UI = 1034.94-1506.99] per 100,000 people). Compared with the global average, a more pronounced decline in ASIR was observed in China from 1793.16 (1446.0-2235.14) in 1990 to 964.70 (801.26-1175.09) per 100,000 people in 2021. CONCLUSIONS Urolithiasis poses a significant healthcare burden worldwide. More robust global and national strategies are warranted to address the prevention and treatment, especially in low SDI countries and regions.
Humans ; Urolithiasis/mortality* ; Male ; Female ; Incidence ; Global Burden of Disease ; Disability-Adjusted Life Years ; Adult ; Middle Aged ; Risk Factors ; Sex Factors

As an acute respiratory infectious disease,the global spread of Coronavirus Disease 2019(COVID-19)has had tremendous impacts on public health.After the acute infection phase,a considerable proportion of infected individuals still experience various symptoms that may persist for weeks to months,or even longer,a condition known as long COVID-19 syndrome.Long-term COVID-19 syndrome exhibits diverse clinical manifestations,with common symptoms in the respiratory system including persistent cough,dyspnea,chest pain,and decreased lung function,which can significantly affect patients' quality of life.This review summarized the common clinical manifestations,pathogene-sis,and advances in diagnosis and treatment of long COVID-19 syndrome in the respiratory system,ai-ming to enhance awareness of respiratory complications associated with long COVID-19,thereby facili-tating more rational responses and the provision of evidence-based strategies for symptom management and pulmonary rehabilitation.

Objective To analyze the differences in bone serum protein between patients with osteoporosis accompanied by obstructive sleep apnea syndrome(OSAS)and those with osteoporosis only using proteomics.Methods A total of 80 osteoporosis patients who attended our hospital between June 2022 and June 2024 were enrolled.Based on their polysomnography results,the participants were divided into an OSAS and osteoporosis comorbidity(OSAS-osteoporosis)group(n=42)and an osteoporosis only group(n=38).Propensity score matching was applied to incorporate covariates in logistic regression so that the individual characteristics of the two groups of patients were generally balanced.Following the matching procedure,a final cohort of 20 matched pairs was obtained and subsequently utilized for further analysis.The mass spectrum was obtained using laser desorption ionization mass spectrometry.Principal component analysis(PCA)was performed to assess differences in metabolic patterns between groups.Partial least squares discriminant analysis(PLS-DA)and orthogonal PLS-DA(OPLS-DA)were employed for further data analysis.Variable importance in projection(VIP)scores of each substance were calculated with OPLS-DA to screen the metabolites showing inter-group differences.Heatmaps were generated to visualize metabolic profile differences between the OSAS-osteoporosis group and the osteoporosis group.Enrichment pathway analysis was conducted on the differential identified metabolites.Results After propensity score matching,individual characteristics between the groups were well balanced.Mass spectrometry revealed significant differences between the OSAS-osteoporosis and osteoporosis groups.In the PCA score plot,the separation trend of the two groups was not significant.The PLS-DA score plot showed a discernible separation trend,with R2 and Q2 lower than those of the corresponding results of the real model,confirming the reliability of the model.OPLS-DA showed that the total R2X of the model was 0.635,R2Y was 0.879,and O2Y was 0.728,showing obvious separation trends between the two groups.A total of 16 differential metabolites were identified,including stearyl-oleyl-glycerol phosphate choline,phosphate choline,L-histidine,erucamide,2'-deoxyuridine,1-palmitoyl glycerol,thymine,tyramine,L-pyroglutamic acid,L-glutamic acid,myristate,glycerol-3-phosphate,caprylic acid,pregnenolone,L-arginine,D-4-hydroxyphenylglycine,and isobutyric acid.Heatmaps showed significant differences in metabolic profiles between the OSAS-osteoporosis group and the osteoporosis group.Pathway enrichment analysis showed that 27 metabolic pathways were involved.27 metabolic pathways.Under the conditions of P<0.05 and pathway impact>0.2,the three most significant metabolic pathways identified included mainly alanine,aspartate,and glutamate metabolism,arginine biosynthesis,and histidine metabolism.Conclusion Significant differences were observed in the metabolic profiles between patients with both OSAS and osteoporosis and those with osteoporosis alone.

Objective:To investigate the safety and feasibility of one-stage flexible ureteroscopic lithotripsy without ureteral access sheath or ureteral stent in the treatment of upper ureteral calculi and renal calculi with a long diameter of≤10 mm.Methods:A total of 70 patients with upper ureteral calculi or renal calculi with a long diameter of≤10 mm who were admitted to Guang'an Hospital,West China Hospital of Sichuan University,from January 2023 to June 2024 were enrolled and randomly divided into experimental group(without ureteral access sheath or ureteral stent)and control group(with ureteral access sheath and ureteral stent),with 35 patients in each group.The patients in the experimental group did not use a ureteral access sheath or a ureteral stent,while those in the control group used the ureteral access sheath and the ureteral stent.The two groups were compared in terms of preoperative data,intraoperative complications,stone clearance rate,length of hospital stay,hospital costs,and postoperative complications.Results:There were no sig-nificant differences between the two groups in preoperative data such as age,body mass index,sex,previous history of stone surgery,af-fected side,maximum stone diameter,C-reactive protein,aggregation system separation,preoperative CT value of stones,and stone lo-cation.The experimental group had a significantly shorter time of operation than the control group[(44.94±52.60)minutes vs.(52.60±14.22)minutes,t=2.240,P=0.030].There were no significant differences between the two groups in intraoperative data such as ureteral injury,intraoperative leukocyte changes,and intraopera-tive blood loss.The experimental group had significantly lower hos-pital costs than the control group[(8041.89±1287.57)yuan vs.(13 011.63±1 780.21)yuan,t=13.450,P=0.000].There were no significant differences between the experimental group and the con-trol group in the postoperative data such as the length of hospital stay,the recurrence of calculi on CT at 1 and 3 months after sur-gery,stone clearance rate,postoperative urinary tract irritation,post-operative ureteral injury,postoperative hematuria,and postoperative hydronephrosis(P>0.05).Conclusion:One-stage flexible uretero-scopic lithotripsy without ureteral access sheath or ureteral stent is safe and feasible in the treatment of upper ureteral calculi and renal calculi with a long diameter of≤10 mm and can effectively reduce hospital costs and time of operation.

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