Objective To investigate the relationship between platelet to lymphocyte ratio(PLR)and low-density lipoprotein cholesterol(LDL-C)/high-density lipoprotein cholesterol(HDL-C)ratio with the degree of carotid artery stenosis,neurological deficits,and prognosis in elderly pa-tients with ischemic stroke and carotid artery stenosis.Methods A total of 186 elderly patients diagnosed with ischemic stroke and carotid artery stenosis admitted in our hospital from June 2021 to June 2024 were enrolled in this study.The PLR and LDL-C/HDL-C ratio were collected,and then with median split,they were divided into high and low PLR groups(both 93 cases),and high and low LDL-C/HDL-C groups(both 93 cases).General clinical data were compared between the two pairs of groups.Multivariate logistic regression analysis was used to identify the factors influencing the severity of carotid artery stenosis,neurological deficits,and prognosis.Kendall's Tau-b correlation analysis was employed to assess the relationship of PLR and LDL-C/HDL-C with the degree of carotid artery stenosis and prognosis.Pearson correlation analysis was conduc-ted to evaluate the association of PLR and LDL-C/HDL-C with neurological deficits.Results Sta-tistically differences were observed in the degree of carotid artery stenosis and prognosis between the high and low PLR groups(P＜0.01).The NIHSS score was significantly higher in the high PLR group(P＜0.01).Similar differences were noted between the high and low LDL-C/HDL-C groups in terms of degree of carotid artery stenosis and prognosis(P＜0.01).The NIHSS score was obviously higher in the high LDL-C/HDL-C group(P＜0.01).Multivariate logistic regression analysis showed that PLR and LDL-C/HDL-C were risk factors for the degree of carotid artery stenosis,neurological deficits and prognosis in elderly patients with carotid artery stenosis after ischemic stroke(OR=3.842,95％CI:2.551-5.328,P=0.000;OR=3.604,95％CI:2.402-5.407,P=0.000;OR=2.956,95％CI:1.955-4.471,P=0.000;OR=3.463,95％CI:2.506-4.785,P=0.000;OR=2.878,95％CI:1.991-4.160,P=0.000;OR=3.785,95％CI:2.483-5.768,P=0.000).Kendall's Tau-b correlation analysis showed that PLR and LDL-C/HDL-C were positively correlated with the degree of carotid artery stenosis and the prognosis in these eld-erly patients(P＜0.05).Pearson correlation analysis indicated that PLR and LDL-C/HDL-C were positively correlated with the NIHSS score in the patients(P＜0.05).Conclusion For the elderly ischemic stroke patients with carotid artery stenosis,PLR and LDL-C/HDL-C are related to the prognosis,and can be used to help assess the severities of carotid artery stenosis and neurological deficits.

Objective:To explore the value of combining gut microbiota and clinical features for preoperative microvascular invasion (MVI) prediction in hepatocellular carcinoma (HCC).Methods:Clinical data and fecal samples were collected from 71 HCC patients who underwent curative resection at Ningbo Second Hospital between Jan 2023 and Aug 2024. Among them, 41 patients were assigned to the training set and 30 to the validation set. Gut microbiota composition was analyzed using 16S rRNA sequencing. Redundancy analysis (RDA) was used to evaluate the influence of clinical features on the microbiota. Differences in alpha and beta diversity between the MVI-negative and MVI-positive groups were assessed. Differential genera were identified using the Wilcoxon test and LEfSe analysis. A random forest model and Logistic regression were employed to screen key differential genera, followed by ROC analysis. Genera with high ROC values were further validated in the validation set.Results:RDA indicated that MVI was a key factor influencing gut microbiota composition. The random forest model (AUC=0.925), combined with Logistic regression analysis, identified four genera: Acidovorax ( OR=0.618), Tissierella ( OR=1.293), Chitinophaga ( OR=4.596), and Virgisporangium ( OR=0.960), as well as two clinical features: tumor diameter ( OR=0.668) and liver cirrhosis ( OR=14.011), as independent risk factors. ROC analysis showed that in the training set, the combination of Chitinophaga (AUC=0.71) and tumor diameter (AUC=0.75) had the best diagnostic performance (AUC=0.87). In the validation set, the combination of Virgisporangium (AUC=0.80) and tumor diameter (AUC=0.79) yielded the highest diagnostic performance (AUC=0.87). Conclusions:A genomics-based model combining gut microbiota and clinical features shows promising predictive value for noninvasive preoperative assessment of MVI status in HCC patients.

Objective To explore the relationship between pathogenic microorganism types,age and season in 2 188 children with respiratory tract infections.Methods A total of 2 188 children with respiratory tract in-fections admitted to the Department of Pediatrics,962 Hospital,Joint Logistic Support Force of PLA from June 2023 to May 2024 were selected as the study subjects.Targeted next generation sequencing(tNGS)tech-nology was used to detect 107 common pathogenic microorganism in children with respiratory tract infections,including Haemophilus influenzae,rhinovirus,Moraxella catarrhalis,Mycoplasma pneumoniae,Staphylococcus aureus,Streptococcus pneumoniae,human parainfluenza virus,human respiratory syncytial virus,etc.The re-spiratory tract infection situation and epidemiological characteristics of children in Harbin were analyzed.Re-sults Among 2 188 pediatric patients,98.5%(2 156/2 188)tested positive for pathogenic microorganism,with Haemophilus influenzae accounting for the highest proportion of 33.5%(732/2 188),followed by rhino-virus of 25.0%(547/2 188)and Moraxella catarrhalis of 24.8%(543/2 188).The positive rates of Hae-mophilus influenzae and human adenovirus in male children were higher than those in female children(P<0.05),while there were no statistically significant differences in the positive positive rates of other pathogenic microorganism between male and female children(P>0.05).Except for human adenovirus and influenza A virus,which showed no statistically significant differences in positive rates among different age groups(P>0.05),there were statistically significant differences in the positive rates of other pathogenic microorganism a-mong different age groups(P<0.05).The positive rates of pathogenic microorganism in preschool children were relatively high.There were no statistically significant differences in the positive rates of Streptococcus and Staphylococcus aureus in different seasons(P>0.05),while there were statistically significant differences in the positive rates of other pathogenic microorganism in different seasons(P<0.05).The positive rates of Haemophilus influenzae,Streptococcus pneumoniae,human metapneumovirus,human parainfluenza virus and SARS-Cov-2 were the highest in summer(P<0.05).Conclusion 2 188 children with respiratory tract infec-tions were mainly caused by pathogenic microorganism such as Haemophilus influenzae,rhinovirus,and Moraxella catarrhalis,etc.Preschool children is a susceptible group,and the prevalence of pathogenic microor-ganism varies seasonally.In clinical practice,relevant prevention and control measures should be developed based on this characteristic to reduce the incidence of diseases.

To describe the incidence and mortality of adult head and neck cancer (HNC) in different regions worldwide and their temporal trends.

Objective To investigate the prevalence of scoliosis and congenital heart disease(CHD)and their correlation among children and adolescents of Drung nationality in Yunnan Province.Methods A cross-sectional survey was conducted in November 2022 among all Drung school-aged children and adolescents aged 5-18 years in Gongshan Drung and Nu Autonomous County,Yunnan Province.Visual inspection,Adams for-ward flexion test,and trunk rotation angle(ATR)measurement were comprehensively used for school prelim-inary screening of scoliosis.Individuals who tested positive in the school preliminary screening underwent fur-ther X-ray examination for auxiliary diagnosis.Cardiac auscultation and echocardiography were used for school preliminary screening of CHD.The personal information of the screening subjects,the screening results,etc.were recorded.The prevalence of scoliosis and CHD among children and adolescents of the Drung nationality and the relationship between the two diseases were statistically analyzed,and the positive predictive value of school-based scoliosis screening and its influencing factors were also analyzed.Results A total of 1 036 chil-dren and adolescents of Drung nationality were enrolled,with a mean age of(10.72±3.75)years,icluding 542 males and 494 females.A total of 45 subjects tested positive for scoliosis in the school preliminary screening,with a preliminary positive rate of 4.34%.A total of 22 cases were finally diagnosed with scoliosis,with a prevalence rate of 2.12%.Among them,21 cases were idiopathic scoliosis(accounting for 95.45%),and 1 case was congenital scoliosis(accounting for 4.55%).The prevalence rate was higher in females(2.83%)than that in males(1.48%),higher in the 10 to 18-year-old group(2.30%)than that in the 5 to<10-year-old group(1.87%),and higher in the secondary school group(2.78%)than that in the primary school group(1.78%),hut there were no statistically significant differences(P>0.05).Most idiopathic scoliosis cases were mild(Cobb angle 10° to<20°,90.48%)and classified as Lenke type Ⅴ(57.14%).Two cases of CHD were confirmed,both of which were atrial septal defects,with a prevalence rate of 0.19%.The co-occurrence rate of idiopathic scoliosis and CHD was 4.76%(1/21).The positive predictive value of school-based scoliosis pre-liminary screening was only 48.89%.When the BMI was<18.5 kg/m2,the positive predictive value was sig-nificantly higher than that for BMI≥18.5 kg/m2(P<0.05).Conclusion The prevalence rate of scoliosis a-mong adolescents of the Drung ethnic group in Yunnan Province is 2.12%,predominantly idiopathic scoliosis,with Lenke type V being the most common classification.The prevalence rate of congenital heart disease is 0.19%.BMI is a significant influencing factor for the positive predictive value of school-based scoliosis prelimi-nary screening.

Objective To explore the cost-benefit of computerized tomography perfusion imaging(CTP)in guiding endovascular treatment of patients with large vessel occlusion associated with delayed time window.Methods A total of 365 patients with great vascular occlusive stroke associated with delayed time window(6-24 h),who were admitted to the Tangshan Municipal Workers' Hospital of China to receive endovascular treatment from January 2016 to February 2022,were enrolled in this study.Based on whether the patient received CTP imaging guidance or not,the treatment cost and benefit of different treatment strategies were analyzed.Modified Rankin scale(mRS)was used to evaluate the patient's postoperative 3-month and 12-month neurological functions.The decision tree-Markov model was used to make cost-benefit analysis.Probability sensitivity analysis(PSA)was used to assess the influence of parameter uncertainty.Results The operation cost of CTP-guided endovascular treatment of large vessel occlusion was 1 526.87 Chinese yuan.According to the calculation method of disease and sequelae burden,it could bring direct burden of 1 089.23 Chinese yuan,direct+indirect burden of 3 204.85 Chinese yuan and direct+indirect+intangible burden of 5 083.07 Chinese yuan.Each Chinese yuan could get 0.178 8,0.231 8 and 0.263 4 earnings,respectively.The therapeutic cost of CTP-guided endovascular treatment of great vascular occlusive stroke was 26 689.13 Chinese yuan,producing 2.065 quality-adjusted life-year(QALY)for each patient,while the therapeutic cost and QALY of non-CTP-guided endovascular treatment were 33 299.07 Chinese yuan and 1.776 QALY respectively.PAS-analyzed incremental cost-benefit ratio(ICER)and incremental net monetary benefit(iNMB)were 22 592.82 and 7 846.43 respectively.At the cost-benefit threshold of ￥50 000/QALY,the probability that CTP guidance could get cost-benefit was up to 90.0％.The tornado chart analysis of one-way sensitivity analysis revealed that the initial mRS distribution guided by CTP had the greatest influence on iNMB,followed by the cost input in the first three months after operation.Conclusion For patients with great vascular occlusive stroke associated with delayed time window,CTP-guided endovascular treatment has high cost-benefit and effect value.

Pediatric uveitis is an inflammatory disease involving iris, ciliary body and choroid. Compared with adult uveitis, pediatric uveitis has insidious onset and is easy to delay treatment. In recent years, biological agents have made remarkable progress in the treatment of non-infectious uveitis (NIU) in children. Anti-tumor necrosis factor-alpha drugs represented by Adalimumab have shown good effects in the control of inflammation, the saving of glucocorticoids, the frequency of uveitis attacks and the improvement of visual prognosis. At the same time, other biologics such as B cell antagonists, T cell antagonists, interleukin-6 antagonists and Janus kinase inhibitors were also gradually tested in children with NIU, bringing good news to children who failed to respond to anti-tumor necrosis factor-alpha drugs. With the in-depth understanding of the diagnosis and treatment of NIU children by clinicians, as well as the characteristics and therapeutic application of various biological agents, it is helpful to develop a more diversified and individualized treatment plan for children, so as to save the vision of children and children's families.

Thyroid cancer is the most common malignant tumor of the endocrine system and head and neck region,mainly including papillary thyroid cancer(PTC),follicular thyroid cancer(FTC),medullary thyroid cancer(MTC)and anaplastic thyroid cancer(ATC).Over the past few decades,the global incidence of thyroid cancer has risen rapidly,nearly doubling in some developed countries.Geographically,thyroid cancer incidence is higher in economically developed regions.Although the fastest increase in incidence has been observed in high-income countries,certain middle-income countries have also reported significant growth.Demographically,the incidence rate is notably higher in women than in men.In China,the incidence of thyroid cancer has increased significantly in recent years,while the mortality rate has remained stable at a low level.Urban areas report higher incidence rates than rural areas,and eastern coastal regions have higher rates compared to central and western regions.The etiology of thyroid cancer is multifaceted,with major risk factors including genetic predisposition,radiation exposure,iodine intake levels,endocrine disruptions,environmental and lifestyle factors.Among these,radiation exposure(particularly ionizing radiation during childhood)is a recognized critical risk factor.In addition,both insufficient and excessive iodine intake can disrupt thyroid function,thereby increasing disease risk.Genetic factors,such as familial clustering and gene(BRAF,RET/PTC,etc.)mutations,have been widely studied,while environmental pollution and modern lifestyles may also contribute to disease onset.Therefore,it is beneficial to conduct early screening for people with a family history of thyroid cancer,reduce unnecessary medical radiation exposure and conduct intervention on lifestyle-related risk factors such as obesity to prevent and control thyroid cancer.Most patients with thyroid cancer have a favorable prognosis.The main factors influencing the prognosis include pathological typing(PTC has a relatively better prognosis,while MTC and ATC have poorer prognoses),clinical staging(patients at TNM stages Ⅰ and Ⅱ have better prognoses,while those at stages Ⅲ and Ⅳ have worse ones),physiological factors(the overall prognosis of females is superior to that of males),genetic factors and environmental factors.Understanding the epidemiological trends and identifying factors influencing the onset and prognosis of thyroid cancer are essential for its prevention,treatment and health management.Future research should focus on identifying high-risk populations and developing targeted interventions to prevent and control thyroid cancer,reduce its disease burden,improve quality of life for patients,and lower healthcare costs.

Objective:To compare the clinical effects of plasma exchange（PE）combined with continuous veno-venous hemodiafiltration（CVVHDF）at different time points in children with Kawasaki disease shock syndrome（KDSS）.Methods:Thirty-five children with KDSS admitted to the intensive care unit of Hunan Children's Hospital from January 2018 to December 2022 were enrolled.According to whether PE combined with CVVHDF was performed within 24 hours after reaching the blood purification criteria for KDSS，the patients were divided into the early treatment group(8 cases) and the control group (27 cases).The clinical and laboratory indicators and prognosis were compared between the two groups.Results:There were no statistically significant differences in age，gender，mean arterial pressure，and pediatric critical illness score between the two groups before treatment（ P>0.05）.In the early treatment group,the vasoactive inotropic score (VIS) gradually decreased,and was significantly lower than that in the control group after 24 hours of treatment.The duration of vasopressor use，pediatric logistic organ dysfunction score（PELOD），inflammatory markers，total hospitalization time，and PICU stay were all lower in the early treatment group than in the control group（ P<0.05）.The incidence of coronary artery involvement within 6 months post-discharge was lower in the early treatment group than in the control group（ P<0.05）.Among the 12 children who underwent PE combined with CVVHDF，four cases were in the late treatment group.The duration of CVVHDF，PICU stay，and PELOD scores were lower in the early treatment group than in the late treatment group（ P<0.05）.Additionally，the concentrations of interleukin-6，tumor necrosis factor-α，heparin-binding protein，and N-terminal pro-brain natriuretic peptide before PE were lower in the early treatment group than in the late treatment group（ P<0.05）. Conclusion:Early PE combined with CVVHDF treatment for KDSS patients can reduce inflammatory response，shorten the course of the disease，and reduce the duration of vasopressor use.However，most patients' conditions can be controlled with active conventional treatment.

Multiple stages of digital fixed restorations may have impact on the occlusal accuracy of the final restorations.Among them, the determination of occlusal plane, the records of static and dynamic occlusion are key stages.Facing the situation of more residual roots, residual crowns, as well as unstable occlusion in elderly people, the accurate occlusal records are of greater significance.This review focuses on above influencing factors combined with evaluation methods for occlusal accuracy.It is believed that in general, whether to transfer personalized occlusion plane should be decided according to the clinical needs, meanwhile fixed restorations made by directly scanning static occlusion under heavy bite force, and obtaining dynamic occlusion using mandibular movement system have more accurate occlusal morphology.However, more randomized controlled clinical trials with large sample size supporting this field of research are still needed for the elderly population.