BackgroundModified electroconvulsive therapy （MECT） is a common front-line strategy widely used in psychiatric practice， and the optimal first stimulus dosage in MECT is usually estimated clinically based on the factors influencing the patient's initial seizure threshold （IST）. However， previous studies on the influencing factors of IST have mostly suffered from limitations such as small sample sizes and single-dimensional research perspectives. ObjectiveTo explore the factors influencing IST in MECT for patients with mental disorders， so as to provide references for stimulus dosing strategies in MECT for the patients. MethodsA retrospective study was used to include 1 446 inpatients fulfilling the diagnostic criteria for any specific mental disorder listed in the ICD-10 and receiving MECT at Shandong Daizhuang Hospital from January 1， 2021 to August 1， 2023. Their general and clinical data were collected， including IST， psychiatric diagnostic categories， gender， ethnicity， age， body weight， body mass index （BMI）， course of disease， family history of psychiatric disorders， first episode status， use of antiepileptic drugs the day before treatment， use of benzodiazepines the day before treatment， and previous MECT treatment history. Pearson correlation analysis was utilized to test the correlation of IST with age， height， body weight， BMI， and course of disease， and stepwise multivariate linear regression analysis was performed to identify the factors affecting IST. ResultsIST yielded statistical difference among patients in terms of gender， first episode status， use of antiepileptic drugs the day before treatment， and use of benzodiazepines the day before treatment （t=2.256， -3.059， -2.136， -3.006， P<0.05 or 0.01）. IST in patients of different ages and psychiatric diagnostic categories also demonstrated statistical difference （F=913.120， 6.212， P<0.01）. Within young population， IST varied significantly based on the psychiatric diagnostic categories （F=2.986， P<0.05）. Correlation analysis indicated that IST was positively correlated with age， body weight， BMI and course of disease （r=0.886， 0.055， 0.184， 0.456， P<0.05 or 0.01）， and negatively correlated with height （r=-0.183， P<0.01）. Stepwise multivariate linear regression analysis revealed that age， gender， and body weight were influencing factors of IST （β=0.888， -0.049， -0.035， P<0.01）. ConclusionsAge， gender and body weight may be factors influencing IST in MECT for patients with mental disorders. ［Funded by Key R&D Plan Projects of Jining City in 2024 (number, 2024YXNS202）］

BACKGROUND:In recent years,with the development of biological scaffold materials and bioprinting technology,tissue-engineered bone has become a research hotspot in bone defect repair. OBJECTIVE:To summarize the current treatment methods for bone defects,summarize the biomaterials and bioprinting technology for preparing tissue-engineered bone scaffolds,and explore the application of biomaterials and printing technology in tissue engineering and the current challenges. METHODS:Search terms were"bone defect,tissue engineering,biomaterials,3D printing technology,4D printing technology,bioprinting,biological scaffold,bone repair"in Chinese and English.Relevant documents published from January 1,2009 to December 1,2022 were retrieved on CNKI,PubMed and Web of Science databases.After being screened by the first author,high-quality references were added.A total of 93 articles were included for review. RESULTS AND CONCLUSION:The main treatment methods for bone defects include bone transplantation,membrane-guided regeneration,gene therapy,bone tissue engineering,etc.The best treatment method is still uncertain.Bone tissue engineering technology is a new technology for the treatment of bone defects.It has become the focus of current research by constructing three-dimensional structures that can promote the proliferation and differentiation of osteoblasts and enhance the ability of bone formation.Biological scaffold materials are diverse,with their characteristics,advantages and disadvantages.A single biological material cannot meet the demand for tissue-engineered bone for the scaffold.Usually,multiple materials are combined to complement each other,which is to meet the demand for mechanical properties while taking into account the biological properties of the scaffold.Bioprinting technology can adjust the pore of the scaffold,build a complex spatial structure,and is more conducive to cell adhesion,proliferation and differentiation.The emerging 4D printing technology introduces"time"as the fourth dimension to make the prepared scaffold dynamic.With the synchronous development of smart materials,4D printing technology provides the possibility of efficient repair of bone defects in the future.

Purpose To establish a nomogram based on conventional ultrasound combined with contrast-enhanced ultrasound(CEUS)for predicting the probability of cervical central lymph node metastasis(CLNM)in clinical lymph node-negative(CN0)papillary thyroid carcinoma(PTC)patients.Materials and Methods A retrospective study was performed on 359 patients with single CN0 PTC,all of whom underwent thyroid surgery and prophylactic central compartment neck dissection in the First Affiliated Hospital of Shihezi University from September 2015 to March 2022.According to the postoperative pathological results,there were 116 cases with CLNM(+)and other 243 cases with CLNM(-).The indicators of gender,age,conventional ultrasound and CEUS were recorded,and multivariate stepwise Logistic regression was performed to screen out risk predictors to construct prediction models for CLNM in CN0 PTC.The receiver operating characteristic curves of prediction models were drawn,and the area under the curve(AUC)was further compared.The preferable prediction model was selected to establish the risk probability nomogram,and the prediction performance and clinical applicability of the nomogram model were assessed.Results Multivariate analysis showed that gender,age,the maximum diameter of nodule,capsule invasion and enhancement pattern on CEUS were risk factors for CLNM in CN0 PTC(all P<0.05).The AUC of prediction model 1 including the above five indicators was 0.753,and the AUC of prediction model 2 excluding CEUS indicator was 0.704.There were statistically significant difference in AUCs between the two models(Z=2.473,P=0.013).Prediction model 1 was selected to construct a risk probability nomogram for predicting CLNM in CN0 PTC.The nomogram had a C-index of 0.753 and showed well consistency on the calibration curve.Clinical decision curve analysis indicated that the nomogram could achieve ideal net benefit when the threshold probability was between 10.7%to 81.5%.Conclusion Gender,age,the maximum diameter of nodule,capsule invasion and enhancement pattern on CEUS may be the risk predictors for CLNM in CN0 PTC.The nomogram model based on the above indicators can predict the probability of CLNM effectively,and the CEUS indicators can substantially improve the prediction performance of the model.

Objective To analyze the current situation of unplanned reoperation in cardiac surgery and to discuss the management measures of unplanned reoperation.Methods The information of patients undergoing cardiac surgery in a class A tertiary comprehensive hospital during 2018-2022 was collected to analyze the incidence of unplanned reoperation,major ca uses,disease types,surgica l moda lities and Complications.Results A tota l of 3902 patients underwent surgery,of whom 73(1.87%)underwent unplanned reoperation.The main cause of unplanned reoperation was bleeding(50%).The disease types with the highest unplanned reoperation composition ratio were coronary heart disease(38.4%),and the disease types with the highest incidence were dilated cardiomyopathy(11.1%).The average hospitalization cost,the average length of hospitalization,mortality rate and medical dispute rate of patients who had unplanned reoperation were significantly higher than those who did not have unplanned reoperation,the difference was statistically significant(P=0.001).Conclusion The hospital should strengthen the perioperative management of cardiac surgery,focus on supervising disease types and surgical modalities with high incidence of unplanned reoperation,and strictly implement the system of operation classification and the system of reporting unplanned reoperation to ensure the quality of patient surgery.

Objective:To evaluate the effect of sevoflurane on Ca 2+ transporter expression in cardiomyocytes during right ventricular remodeling in rats with pulmonary arterial hypertension. Methods:Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 200-250 g, were divided into 4 groups ( n=6 each) by the random number table method: control group (CM group), sevoflurane group (CS group), monocrotaline group (M group) and sevoflurane + monocrotaline group (S group). Monocrotaline 60 mg/kg was intraperitoneally injected in group M and group S, and monocrotaline lysate was intraperitoneally injected in group CM. The rats in S and CS groups inhaled 2.5% sevoflurane for 1 h, twice a week, at an interval of 3 days starting from the first day after injection of monocrotaline. Pulmonary artery acceleration time and pulmonary artery ejection time were measured by transthoracic echocardiography at 6 weeks after monocrotaline injection. The chest was exposed under 3% sevoflurane anesthesia, the heart was perfused, and the pulmonary artery branch and right ventricular myocardial tissues were retained. The wall thickness of pulmonary arterioles and cross-section area of right ventricular cardiomyocytes were observed by HE staining. The expression of Ca 2+ transporter in right ventricular cardiomyocytes was detected by Western blot. Results:Compared with CM group, the ratio of pulmonary artery acceleration time to pulmonary artery ejection time was significantly decreased, the cross-section area of right ventricular cardiomyocytes was increased, the wall thickness of pulmonary arteriole was increased, the expression of type 1 sodium-calcium exchange and inositol triphosphate receptor was up-regulated, and the expression of voltage-dependent L-type calcium channel α1C subunit, type 2 ryanodine receptor, sarcoplasmic reticulum calcium pump 2α and proteinphilin-2 was down-regulated in M group ( P<0.01). Compared with group M, the ratio of pulmonary artery acceleration time to pulmonary artery ejection time was significantly increased, the cross-section area of right ventricular cardiomyocytes was decreased, the wall thickness of pulmonary arteriole was decreased, the expression of type 1 sodium-calcium exchange and inositol triphosphate receptor was down-regulated, and the expression of voltage-dependent L-type calcium channel α1C subunit, type 2 ryanodine receptor, sarcoplasmic reticulum calcium pump 2α and proteinphilin-2 was up-regulated in group S ( P<0.01). Conclusions:The mechanism by which sevoflurane improves right ventricular remodeling is related to regulating the expression of Ca 2+ transporter in cardiomyocytes of rats with pulmonary arterial hypertension.

Cardiometabolic disease is a clinical syndrome with a causal relationship between metabolic abnormalities and cardiovascular damage. With its global incidence and related mortality rates continually rising， it has become a major health concern worldwide. The role of the gut microbiome and its metabolic products in cardiovascular metabolic health has received widespread attention， with gut microbiota dysbiosis considered a key factor in promoting the development of cardiometabolic disease. Dysbiosis disrupts the balance of the "heart-spleen-intestine" axis， leading to dysfunction of the spleen and intestines， which triggers metabolic disorders and accelerates the progression of cardiometabolic disease. Cardiac dysfunction can also negatively affect spleen and intestinal function， leading to imbalances in the heart and spleen， disharmony in Qi and blood， and exacerbating metabolic anomalies and further dysbiosis， thus forming a vicious cycle. From a modern biological perspective， the gut microbiome and its metabolic products can influence disease progression by modulating inflammatory responses and immune imbalances， leading to endothelial dysfunction and metabolic disorders， thereby increasing the risk of cardiometabolic disease. Additionally， the article proposes strategies for managing cardiometabolic disease by regulating the gut microbiome through a combination of Chinese and western medicine approaches. Traditional Chinese medicine（TCM） treatment starts from the gut microbiome， using the "heart-spleen-intestine" axis as a mediator to regulate cardiovascular metabolic health， highlighting the unique advantages of TCM in targeting the gut microbiome to treat cardiometabolic disease. This article takes the TCM theory of the "heart-spleen-intestine" axis as a starting point， discusses the pivotal role played by this axis in the connection between gut microbiome dysbiosis and the development of cardiometabolic disease， aiming to provide a new perspective for the integrated traditional Chinese and western medical research on cardiometabolic disease， offering scientific evidence and practical guidance to improve the prognosis and quality of life for patients.

Objective:To investigate the value of implantable cardiac monitor (ICM) in the diagnosis and treatment of patients over 60 years old with unexplained syncope.Methods:This was a multi-center, prospective cohort study. Between June 2018 and April 2021, patients over the age of 60 with unexplained syncope at Beijing Hospital, Fuwai Hospital, Beijing Anzhen Hospital and Puren Hospital were enrolled. Patients were divided into 2 groups based on their decision to receive ICM implantation (implantation group and conventional follow-up group). The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up. Kaplan‐Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups. A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope.Results:A total of 198 patients with unexplained syncope, aged (72.9±8.25) years, were followed for 558.0 (296.0,877.0) d, including 98 males (49.5%). There were 100 (50.5%) patients in the implantation group and 98 (49.5%) in the conventional follow-up group. Compared with conventional follow-up group, patients in the implantation group were older, more likely to have comorbidities, had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram, and had a lower body mass index (all P<0.05). During the follow-up period, positive cardiac arrhythmia events were recorded in 58 (58.0%) patients in the ICM group. The diagnosis rate (42.0% (42/100) vs. 4.1% (4/98), P<0.001) and the intervention rate (37.0% (37/100) vs. 2.0% (2/98), P<0.001) of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group (all P<0.001). Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group ( HR=11.66, 95% CI 6.49-20.98, log-rank P<0.001). Multivariate analysis indicated that ICM implantation, previous atrial fibrillation, diabetes mellitus or first degree atrioventricular block in baseline electrocardiogram were independent predictors for cardiogenic syncope (all P<0.05). Conclusions:ICM implantation improves the diagnosis and intervention rates in patients with unexplained syncope, and increases diagnostic efficiency in patients with unexplained syncope.

Objective:To explore the potential relationship between sugar metabolism,acid production and cariogenicity of Prevotella denticola.Methods:Morphological features of Prevotella denticola were observed and respectively cultured under incubation conditions with and without sugar and at different pH values.The growth characteristics of Prevotella denticola were detected by UV-Vis spectro-photometer and pH meter,the organic acid content in the culture supernatants of the cultures was detected by HPLC.Dentin slices were divided into control group,phosphoric acid group and the Prevotella denticola group and cultured in the corresponding mediu for 1 and 2 weeks respectively,the degree of demineralization of the samples was examined SEM and VHM.Results:Prevotella denticola fermen-ted sucrose and glucose,produced acids with its final pH values as low as 4.7,Succinic acid and acetic acid were its main metabolites.Prevotella denticola was moderately acid-tolerant.Furthermore,Prevotella denticola was able to cause dentin demineralization,and the Vickers hardness value of dentin samples in the Prevotella denticola group was significantly decreased compared with the control group(P＜0.05).Conclusion:The cariogenic capacity of Prevotella denticola may be related to its sugar metabolism and acid production.

Objective:To evaluate the endometrial implantation window in patients with recurrent implantation failure using endometrial receptive array(ERA)sequencing or endometrial histological detection methods,and to explore the effectiveness and cost-effectiveness analysis of two technologies for improving clinical outcomes in such patients.Methods:A retrospective cohort study was conducted on clinical data of 125 patients diagnosed with repeated implantation failure in Gansu Maternal and Child Health Hospital from January 2018 to December 2022.According to whether endometrial receptivity testing was accepted and different detection techniques were used,they were divided into a control group(n=36),a genomic group(n=35),and a histological group(n=54).The clinical data and pregnancy outcomes of the three groups were compared.Results:①The results of one-way ANOVA showed that the embryo implantation rate in the genomic group and histological group was significantly higher than that in the control group,and the difference was statistically significant(P＜0.05).There was no sta-tistically significant difference in embryo implantation rate between genomic and histological groups(P=0.48).②There was no statistically significant difference in clinical pregnancy rate and live birth rate among the three groups(P＞0.05).③Log rank test showed:The time for 50％of patients to reach live labor was significantly shorter than that of the control group,and the difference was statistically significant(P＜0.05);There was no sta-tistically significant difference in the time to live birth in 50％of patients between the genomic and histological groups of 50％of patients(P＞0.05).④The average number of embryos transferred in the control group was significantly higher than that in the genomic and histological groups,with statistical significance(P＜0.05).The cost of genomic patients was significantly higher than that of histology group,and the difference was statistically significant(P＜0.05).Conclusions:①Endometrial implantation window detection is feasible for patients with re-peated implantation failure,which can effectively shorten the time to live birth and reduce the number of transplan-ted embryos;②Both ERA sequencing and endometrial histology detection have limitations as methods to evaluate endometrial implantation window,and it is not clear which detection method has more advantages in accuracy and practicability.

Objective To explore the current status of medical device of clinical trial institutions specializing in psychiatry,neurology,and neurosurgery in China after the implementation of the registration system.Methods By searching the medical device clinical trial institution registration management information platform,statistical analysis was conducted on the number,category and grades,geographical distribution,number of principal investigators and aptitude,and cross-distribution of medical device clinical trial institutions specializing in psychiatry,neurology,and neurosurgery.Results Since the implementation of the registration system,up to August 6,2024,111 psychiatric,588 neurological,and 418 neurosurgical institutions that had registered distributed across 27,30,and 29 provincial-level administrative regions in China,respectively.Among these institutions,73.0％,66.5％and 76.6％were tertiary grade A hospitals,respectively.The number of registered principal investigators were 524,1635 and 1128 persons,respectively.The registered institutions were mainly distributed in relatively developed urban clusters in the Yangtze River Delta,Pearl River Delta,and Beijing-Tianjin-Hebei region.Conclusion Tertiary grade A hospitals dominate medical device clinical trial institutions specializing in psychiatry,neurology and neurosurgery in China.The implementation of the registration system has promoted the release of medical resources in the neuropsychiatric field.However,issues such as significant regional differences in the number of clinical trial institutions and the concentration of researcher resources exist.