Objective:To verify the causal relationship between tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-12 (IL-12) and gout using Mendelian randomization (MR) analysis. The findings are expected to provide insights into whether TNF-α, IL-6, IL-12 antagonists and other biological agents can be applied in the treatment of refractory gout (RG) in clinical practice.Methods:This study conducted a two-sample MR using publicly available summary statistics from an independent European ancestry cohort. For the data on TNF-α, IL-6, and IL-12, data were retrieved from the GWAS catalog database. For the gout data, to avoid confounding, the FinnGen database was used. The analysis was performed using R4.3.2 software. The statistical significance threshold was set at P<5×10 -5. Linkage disequilibrium (LDA was set to R2>0.001) was removed, and strongly correlated and independent single nucleotide polymorphism (SNP) loci were selected for analysis. Five methods were used for analysis: inverse variance weighting (IVW), MR Egger, weighted median, simple mode, and weighted mode. IVW was used as the main analysis method. When pleiotropy was present, MR-Egger estimates were considered more persuasive than IVW estimates, so MR-Egger was taken as the primary analysis method. Cochran′s Q test and MR-Egger intercept test were used to assess heterogeneity and pleiotropy. The leave-one-out method was used to test the stability of MR results by systematically excluding instrumental variables (IVs). Finally, a reverse MR analysis of gout and TNF-α, IL-6, IL-12 was conducted. Results:The IVW-MR, MR Egger, weighted median, simple mode, and weighted mode analyses showed no causal relationship between IL-6, IL-12, and gout (all P>0.05). Cochran′s Q test and MR-Egger intercept test results showed no significant heterogeneity or horizontal pleiotropy affecting causal estimates (all P>0.05). The leave-one-out test indicated stable results. MR-Egger analysis showed a weak causal relationship between TNF-α and gout [ OR(95% CI)=0.892 (0.812, 0.979), b=-0.113, P=0.021], while the other methods (IVW-MR, weighted median, simple mode, weighted mode) showed no causal relationship between TNF-α and gout (all P>0.05). Cochran′s Q test indicated no heterogeneity affecting causal estimates ( P>0.05), but MR-Egger intercept test suggested the presence of horizontal pleiotropy affecting causal estimates ( P<0.05). The reverse MR analysis of gout and TNF-α, IL-6, IL-12 showed no causal relationships (all P>0.05). No significant heterogeneity or horizontal pleiotropy affected causal estimates (all P>0.05), and the leave-one-out test indicated that the results were stable. Conclusion:MR analysis suggests that there is no causal relationship between IL-6, IL-12, and gout, but TNF-α may have a weak causal relationship with gout. More accurate and solid evidence are needed from further prospective randomized controlled trials.

Objective:To evaluate the diagnostic performance of resting echocardiography in detecting severe coronary artery stenosis.Methods:A total of 136 patients with suspected coronary artery disease（CAD）who presented to Sichuan Provincial People's Hospital between January 2021 and December 2024 were prospectively enrolled. All patients underwent both coronary computed tomography angiography（CCTA）and transthoracic echocardiography within one week. Based on CCTA results，the patients were divided into non-severe stenosis group（ n=78）and severe stenosis group（ n=58）. Echocardiographic parameters including left atrial maximum volume（LAVmax），left ventricular global longitudinal strain（GLS），left ventricular longitudinal strain of endo-myocardium，mid-myocardium，epi-myocardium（LSendo，LSmid，LSepi），early diastolic mitral inflow velocity（E），early diastolic mitral annular velocity of the lateral and septal walls（e'），and E/e' were measured. Predictive factors for severe coronary stenosis were identified using LASSO regression，and a nomogram model was developed via multivariate Logistic regression. Model performance was evaluated using ROC curves，calibration curves，and decision curve analysis. Results:Multivariate Logistic regression analysis revealed LSendo，LAVmax，and E/e' as independent predictors of severe coronary artery stenosis. The nomogram constructed based on these predictors achieved an area under the curve of 0.798（95% CI=0.723-0.873），with sensitivity and specificity of 0.756 and 0.759，respectively. Conclusions:The resting echocardiography-based nomogram model demonstrates good diagnostic efficacy for severe coronary artery stenosis. It may serve as a noninvasive tool to assist in risk stratification and clinical decision-making in patients with suspected CAD.

Objective:To investigate children's attention deficit hyperactivity disorder symptoms and their im-pact on parental anxiety and depression,as well as the mediating role of parent-child relationship.Methods:A total of 472 children with ADHD who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Dis-orders,Fourth Edition(DSM-Ⅳ)were selected.The severity of ADHD symptoms was assessed using the Attention Deficit Hyperactivity Disorder Rating Scale(ADHD-RS),parent-child relationships were assessed using the Parent-Child Relationship Test(PCRT),and parental anxiety and depression were assessed using the Generalized Anxiety Disorder 7-item Scale(GAD-7)and the Patient Health Questionnaire-9(PHQ-9),respectively.Mediation analysis was conducted following structural equation modeling construction.Results:There was a positive correlation be-tween ADHD-RS scores and PCRT scores,parental GAD-7 scores,and PHQ-9 scores(r=0.19-0.29,Ps＜0.001).PCRT scores significantly mediated the relationship between ADHD-RS total scores and parental GAD-7 and PHQ-9 scores(β=0.02-0.03,Ps＜0.05).PCRT scores did not significantly mediate the relationship between ADHD-RS inattention scores and parental GAD-7 and PHQ-9 scores(β=0.01-0.02,Ps＞0.05).PCRT scores significantly mediated the relationship between ADHD-RS hyperactivity/impulsivity scores and parental GAD-7 and PHQ-9 scores(β=0.02,Ps＜0.05).Conclusion:The symptoms of ADHD in children are associated with parental anxiety and depression symptoms,with parent-child relationships mediating this relationship.

To address the problem of data silos in dental specialties caused by equipment heterogeneity, this study developed an Intelligent Internet of Things (IoT)-enabled dental chair platform (hereinafter referred to as the intelligent platform) based on the concept of medical-engineering integration. The platform adopts a three-tier chair-domain interconnection architecture: the bottom tier integrates multi-source sensors and standardized interfaces for automated data acquisition and linkage with hospital information systems; the middle tier provides clinic-level management and remote teaching collaboration; and the top tier employs a blockchain-based secure cloud database for resource allocation and data management. Clinical validation at The Affiliated Stomatological Hospital of Nanjing Medical University demonstrated that, compared with a control group from the same period in 2023, the trial group achieved a 38.0% increase in average daily patient visits (80.6±6.8 vs. 58.4±5.2, t=15.16, P<0.001), a 24.6% reduction in average treatment time [(36.1±6.3) min vs. (47.9±8.5) min, t=7.72, P<0.001], a 39.2% reduction in waiting time [23.3 (16.5, 30.1) min vs. 38.3 (28.3, 48.3) min, U=32.00, P<0.001], a 30.4% reduction in equipment idle rate [8.7% (5.1%, 12.3%) vs. 12.5% (7.4%, 17.6%), U=251.00, P=0.003], and an increase in patient satisfaction from 88.2% (1 519/1 723) to 94.3% (2 186/2 318) ( t=7.26, P<0.001). User research confirmed that the functions most favored by clinicians and patients were "dental chair parameter updating and clinical data integration" [74.7% (80/107)] and "chairside display of diagnostic images" [76.8% (119/155)], respectively. Looking forward, the intelligent platform has the potential to integrate artificial intelligence-assisted diagnosis and 5G-enabled multicenter collaboration to further expand its clinical applications and accelerate the digital transformation of dental healthcare.

Objective:To study the effects of aluminum exposure on learning and memory and the expression of nerve growth factor(NGF)in the hippocampus of offspring rats,and to investigate the mechanism by which aluminum impairs learning and memory function.Methods:Forty pregnant Wistar rats were randomly assigned to the Control group(Control),low-dose Al group(Al-L),medium-dose Al group(Al-M)and high-dose Al group(Al-H).The off-spring rats were fed with Al through breast milk from birth to weaning,while the rats in the control group were fed with distilled water.The maternal rats Al-L,Al-M and Al-H groups drank distilled water solution containing 2.0,4.0 and 8.0 g/L AlCl3,respectively.After weaning,the offspring rats in the aluminum exposure group drank distilled water so-lution containing 2.0,4.0 and 8.0 g/L AlCl3 by themselves until the 90th day after birth to establish the offspring rat model of subchronic aluminum exposure.After aluminum exposure,the shuttle box test was used to detect the learning and memory ability of offspring rats,and the body weight of offspring rats and hippocampus were weighed to evaluate the effect of aluminum exposure.The expression of nerve growth factor(NGF)protein in hippocampus of offspring rats was detected by Western blot,and the expression of NGF mRNA in hippocampus of offspring rats was detected by real time RT-PCR.Results:The body weight of offspring rats in Al-H group was significantly lower than that in the other three dose groups.In the shuttle box test,compared with the control group,the active avoidance response and passive avoid-ance response of the offspring rats in the aluminum exposure group showed a downward trend with the increase of alumi-num exposure dose,indicating that the learning and memory ability of the offspring rats in the aluminum exposure group was impaired.Compared with the control group,the NGF protein content and NGF mRNA expression in the hippocam-pus of offspring rats in the aluminum exposure group were significantly decreased.Conclusion:Subchronic aluminum exposure down-regulates the expression of NGF in the hippocampus,which may cause learning and memory impairment in offspring rats.

Objective:To evaluate the diagnostic performance of resting echocardiography in detecting severe coronary artery stenosis.Methods:A total of 136 patients with suspected coronary artery disease（CAD）who presented to Sichuan Provincial People's Hospital between January 2021 and December 2024 were prospectively enrolled. All patients underwent both coronary computed tomography angiography（CCTA）and transthoracic echocardiography within one week. Based on CCTA results，the patients were divided into non-severe stenosis group（ n=78）and severe stenosis group（ n=58）. Echocardiographic parameters including left atrial maximum volume（LAVmax），left ventricular global longitudinal strain（GLS），left ventricular longitudinal strain of endo-myocardium，mid-myocardium，epi-myocardium（LSendo，LSmid，LSepi），early diastolic mitral inflow velocity（E），early diastolic mitral annular velocity of the lateral and septal walls（e'），and E/e' were measured. Predictive factors for severe coronary stenosis were identified using LASSO regression，and a nomogram model was developed via multivariate Logistic regression. Model performance was evaluated using ROC curves，calibration curves，and decision curve analysis. Results:Multivariate Logistic regression analysis revealed LSendo，LAVmax，and E/e' as independent predictors of severe coronary artery stenosis. The nomogram constructed based on these predictors achieved an area under the curve of 0.798（95% CI=0.723-0.873），with sensitivity and specificity of 0.756 and 0.759，respectively. Conclusions:The resting echocardiography-based nomogram model demonstrates good diagnostic efficacy for severe coronary artery stenosis. It may serve as a noninvasive tool to assist in risk stratification and clinical decision-making in patients with suspected CAD.

To address the problem of data silos in dental specialties caused by equipment heterogeneity, this study developed an Intelligent Internet of Things (IoT)-enabled dental chair platform (hereinafter referred to as the intelligent platform) based on the concept of medical-engineering integration. The platform adopts a three-tier chair-domain interconnection architecture: the bottom tier integrates multi-source sensors and standardized interfaces for automated data acquisition and linkage with hospital information systems; the middle tier provides clinic-level management and remote teaching collaboration; and the top tier employs a blockchain-based secure cloud database for resource allocation and data management. Clinical validation at The Affiliated Stomatological Hospital of Nanjing Medical University demonstrated that, compared with a control group from the same period in 2023, the trial group achieved a 38.0% increase in average daily patient visits (80.6±6.8 vs. 58.4±5.2, t=15.16, P<0.001), a 24.6% reduction in average treatment time [(36.1±6.3) min vs. (47.9±8.5) min, t=7.72, P<0.001], a 39.2% reduction in waiting time [23.3 (16.5, 30.1) min vs. 38.3 (28.3, 48.3) min, U=32.00, P<0.001], a 30.4% reduction in equipment idle rate [8.7% (5.1%, 12.3%) vs. 12.5% (7.4%, 17.6%), U=251.00, P=0.003], and an increase in patient satisfaction from 88.2% (1 519/1 723) to 94.3% (2 186/2 318) ( t=7.26, P<0.001). User research confirmed that the functions most favored by clinicians and patients were "dental chair parameter updating and clinical data integration" [74.7% (80/107)] and "chairside display of diagnostic images" [76.8% (119/155)], respectively. Looking forward, the intelligent platform has the potential to integrate artificial intelligence-assisted diagnosis and 5G-enabled multicenter collaboration to further expand its clinical applications and accelerate the digital transformation of dental healthcare.

Objective:To investigate children's attention deficit hyperactivity disorder symptoms and their im-pact on parental anxiety and depression,as well as the mediating role of parent-child relationship.Methods:A total of 472 children with ADHD who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Dis-orders,Fourth Edition(DSM-Ⅳ)were selected.The severity of ADHD symptoms was assessed using the Attention Deficit Hyperactivity Disorder Rating Scale(ADHD-RS),parent-child relationships were assessed using the Parent-Child Relationship Test(PCRT),and parental anxiety and depression were assessed using the Generalized Anxiety Disorder 7-item Scale(GAD-7)and the Patient Health Questionnaire-9(PHQ-9),respectively.Mediation analysis was conducted following structural equation modeling construction.Results:There was a positive correlation be-tween ADHD-RS scores and PCRT scores,parental GAD-7 scores,and PHQ-9 scores(r=0.19-0.29,Ps＜0.001).PCRT scores significantly mediated the relationship between ADHD-RS total scores and parental GAD-7 and PHQ-9 scores(β=0.02-0.03,Ps＜0.05).PCRT scores did not significantly mediate the relationship between ADHD-RS inattention scores and parental GAD-7 and PHQ-9 scores(β=0.01-0.02,Ps＞0.05).PCRT scores significantly mediated the relationship between ADHD-RS hyperactivity/impulsivity scores and parental GAD-7 and PHQ-9 scores(β=0.02,Ps＜0.05).Conclusion:The symptoms of ADHD in children are associated with parental anxiety and depression symptoms,with parent-child relationships mediating this relationship.

Objective:To study the effects of aluminum exposure on learning and memory and the expression of nerve growth factor(NGF)in the hippocampus of offspring rats,and to investigate the mechanism by which aluminum impairs learning and memory function.Methods:Forty pregnant Wistar rats were randomly assigned to the Control group(Control),low-dose Al group(Al-L),medium-dose Al group(Al-M)and high-dose Al group(Al-H).The off-spring rats were fed with Al through breast milk from birth to weaning,while the rats in the control group were fed with distilled water.The maternal rats Al-L,Al-M and Al-H groups drank distilled water solution containing 2.0,4.0 and 8.0 g/L AlCl3,respectively.After weaning,the offspring rats in the aluminum exposure group drank distilled water so-lution containing 2.0,4.0 and 8.0 g/L AlCl3 by themselves until the 90th day after birth to establish the offspring rat model of subchronic aluminum exposure.After aluminum exposure,the shuttle box test was used to detect the learning and memory ability of offspring rats,and the body weight of offspring rats and hippocampus were weighed to evaluate the effect of aluminum exposure.The expression of nerve growth factor(NGF)protein in hippocampus of offspring rats was detected by Western blot,and the expression of NGF mRNA in hippocampus of offspring rats was detected by real time RT-PCR.Results:The body weight of offspring rats in Al-H group was significantly lower than that in the other three dose groups.In the shuttle box test,compared with the control group,the active avoidance response and passive avoid-ance response of the offspring rats in the aluminum exposure group showed a downward trend with the increase of alumi-num exposure dose,indicating that the learning and memory ability of the offspring rats in the aluminum exposure group was impaired.Compared with the control group,the NGF protein content and NGF mRNA expression in the hippocam-pus of offspring rats in the aluminum exposure group were significantly decreased.Conclusion:Subchronic aluminum exposure down-regulates the expression of NGF in the hippocampus,which may cause learning and memory impairment in offspring rats.

Objective:To verify the causal relationship between tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-12 (IL-12) and gout using Mendelian randomization (MR) analysis. The findings are expected to provide insights into whether TNF-α, IL-6, IL-12 antagonists and other biological agents can be applied in the treatment of refractory gout (RG) in clinical practice.Methods:This study conducted a two-sample MR using publicly available summary statistics from an independent European ancestry cohort. For the data on TNF-α, IL-6, and IL-12, data were retrieved from the GWAS catalog database. For the gout data, to avoid confounding, the FinnGen database was used. The analysis was performed using R4.3.2 software. The statistical significance threshold was set at P<5×10 -5. Linkage disequilibrium (LDA was set to R2>0.001) was removed, and strongly correlated and independent single nucleotide polymorphism (SNP) loci were selected for analysis. Five methods were used for analysis: inverse variance weighting (IVW), MR Egger, weighted median, simple mode, and weighted mode. IVW was used as the main analysis method. When pleiotropy was present, MR-Egger estimates were considered more persuasive than IVW estimates, so MR-Egger was taken as the primary analysis method. Cochran′s Q test and MR-Egger intercept test were used to assess heterogeneity and pleiotropy. The leave-one-out method was used to test the stability of MR results by systematically excluding instrumental variables (IVs). Finally, a reverse MR analysis of gout and TNF-α, IL-6, IL-12 was conducted. Results:The IVW-MR, MR Egger, weighted median, simple mode, and weighted mode analyses showed no causal relationship between IL-6, IL-12, and gout (all P>0.05). Cochran′s Q test and MR-Egger intercept test results showed no significant heterogeneity or horizontal pleiotropy affecting causal estimates (all P>0.05). The leave-one-out test indicated stable results. MR-Egger analysis showed a weak causal relationship between TNF-α and gout [ OR(95% CI)=0.892 (0.812, 0.979), b=-0.113, P=0.021], while the other methods (IVW-MR, weighted median, simple mode, weighted mode) showed no causal relationship between TNF-α and gout (all P>0.05). Cochran′s Q test indicated no heterogeneity affecting causal estimates ( P>0.05), but MR-Egger intercept test suggested the presence of horizontal pleiotropy affecting causal estimates ( P<0.05). The reverse MR analysis of gout and TNF-α, IL-6, IL-12 showed no causal relationships (all P>0.05). No significant heterogeneity or horizontal pleiotropy affected causal estimates (all P>0.05), and the leave-one-out test indicated that the results were stable. Conclusion:MR analysis suggests that there is no causal relationship between IL-6, IL-12, and gout, but TNF-α may have a weak causal relationship with gout. More accurate and solid evidence are needed from further prospective randomized controlled trials.