Objective: To investigate the association between monocyte to high-density lipoprotein cholesterol ratio (MHR) and periodontitis and to provide new epidemiologic evidence on the factors affecting periodontitis. Methods: Data on MHR, periodontitis, and other covariates were selected from the NHANES(National Health and Nutrition Examination) database for 3 cycles of subjects in 2009-2010, 2011-2012, and 2013-2014, and a total of 8 456 study subjects were included. The study participants were grouped according to the prevalence of periodontitis (presence or absence), and three regression models (unadjusted covariates, partially adjusted covariates, and fully adjusted covariates) were constructed to analyze the relationship between MHR and periodontitis by using a weighted logistic regression method with stepwise adjustment for confounders. MHR was divided into four groups from Q1 to Q4 according to quartiles from small to large for weighted trend analysis, and the nonlinear relationship between MHR (continuous) and periodontitis was analyzed using a restricted cubic spline with subgroup analysis and sensitivity analysis. Results: All three logistic regression models showed a positive association between MHR and periodontitis (OR = 2.92, 95%CI: 2.14-3.99, P<0.001 (not adjusted); OR = 1.97, 95%CI: 1.39-2.78, P<0.001 (partially adjusted); OR = 1.62, 95%CI: 1.10-2.39, P = 0.017 (fully adjusted)). Trend analysis showed a significantly higher risk of developing periodontitis in the Q4 group compared with the Q1 group in both single (OR = 1.92, 95% CI: 1.58-2.33, P<0.001) and multifactorial analyses (OR = 1.30, 95% CI: 1.03-1.64, P = 0.029). Restricted cubic spline results did not support a nonlinear relationship between MHR and periodontitis (P for nonlinear>0.05), subgroup analysis showed no significant interaction between the covariates and MHR (P>0.05), and sensitivity analysis also showed a positive correlation between MHR and periodontitis (OR = 1.67, 95%CI: 1.31-2.14, P<0.001). Conclusion MHR is positively associated with the risk of developing periodontitis.

Objective:To evaluate the 1-year postoperative efficacy and nutritional indicators of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in obese patients.Methods:This retrospective observational study included patients with a body mass index (BMI) of ≥40.0 kg/m 2 regardless of other related metabolic diseases and patients with severe type 2 diabetes and a BMI between 27.5 and 40.0 kg/m 2. The clinical data of 66 obese patients who underwent SADI-S at the Bariatric and Metabolic Surgery Department of China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were collected, including 53 cases of da Vinci robotic surgery and 13 cases of laparoscopic surgery. The patients comprised 38 men and 28 women with a median age of 35 (18–61) years and a mean preoperative BMI of 42.93 ± 6.82 kg/m 2. A total of 38 patients had type 2 diabetes, and 46 had hyperuricemia, 45 had hypertension, 35 had hyperlipidemia, 12 had hypercholesterolemia, and 12 had a high low-density lipoprotein (LDL) level. The main observation indicators were (1) intraoperative and postoperative conditions; (2) weight loss outcomes, including body weight, BMI, excess body weight loss (%EWL), and total body weight loss (%TWL) at 3, 6, and 12 months after surgery; (3) effects of treatment on metabolic disease; and (4) changes in nutrient indicators. Results:(1) Intraoperative and postoperative conditions: All patients successfully underwent SADI-S with neither conversion to laparotomy nor death. Four (6.1%) patients developed postoperative complications, and all of them recovered and were discharged after conservative or surgical treatment. (2) Weight loss outcomes: %EWL at 3, 6, and 12 months after surgery was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65, respectively, and %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89, respectively. Body weight and BMI 3 to 12 months after surgery were significantly lower than those before surgery (all P < 0.001). (3) Effect of treatment on metabolic disease: 3 to 12 months after surgery, fasting blood sugar, HbA1c, uric acid, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL, and other indicators were significantly lower than those before surgery (all P < 0.05). Twelve months after surgery, the remission rates of diabetes, hyperuricemia, hypertension, hypertriglyceridemia, hypercholesterolemia, and high LDL were 100% (38/38), 65.2% (30/46), 62.2% (28/45), 94.3% (33/35), 100% (12/12), and 100% (12/12), respectively. (4) Changes in nutrient indicators: Compared with the preoperative nutrient levels, the hemoglobin and hematocrit levels were lower at 3 to 12 months after surgery, the total protein level was lower at 6 to 12 months after surgery, the albumin level was lower at 6 months after surgery, and the ferritin level was lower at 3 months after surgery. The differences were statistically significant (all P < 0.05). The incidence of anemia was 6.1% (4/66), hypoalbuminemia was 4.5% (3/66), and ferritin deficiency was 4.5% (3/66), all of which were improved or normalized through conservative treatment. Twelve months after surgery, 30 (45.5%) patients had vitamin A deficiency, 17 (25.8%) had vitamin E deficiency, 11 (16.7%) had folic acid deficiency, 2 had potassium deficiency (3.0%), 3 (4.5%) had calcium deficiency, 2 (3.0%) had magnesium deficiency, 9 (13.6%) had iron deficiency, and 16 (24.2%) had zinc deficiency. However, no relevant clinical symptoms occurred. Conclusions:SADI-S has a very significant effect on weight loss and alleviation of metabolic diseases. Nutrient deficiencies after SADI-S mainly involve vitamin A, vitamin E, zinc, and folic acid. The long-term efficacy and safety of SADI-S still need further follow-up observation.

Objective:To study the dosimetric differences of hippocampal-avoidance whole brain radiotherapy(HA-WBRT)between non-uniform 9-fields intensity-modulated radiotherapy-flatten filter(9F-IMRT-FF)and 9-fields intensity-modulated radiotherapy-flatten filter-free(9F-IMRT-FFF)mode.Methods:From January to December 2023,the simulated images of computed tomography(CT)location of 20 patients with intracranial metastases who had completed whole-brain radiotherapy at the Department of Radiotherapy of Chengde Central Hospital were selected.The radiotherapy plans of two kinds of modes of brand-new 9F-IMRT-FF and 9F-IMRT-FFF were redesigned in the planning system.The differences of dosimetric parameters of the two kinds of mode plans were compared,as well as the differences of irradiation efficiency of accelerator.Results:The exposure dose(D2%)of 2%volume of target region of planned target volume(PTV)of 9F-IMRT-FFF mode was significantly lower than that of 9F-IMRT-FF mode(t=-2.496,P<0.05).The exposure dose(D100%)of 100%volume of target region,the maximum dose(Dmax)and the mean dose(Dmean)of the left side of hippocampus of 9F-IMRT-FFF mode plan were significantly lower than those of 9F-IMRT-FF mode plan,with statistically significant(Z=-3.179,-3.018,-2.145,P<0.05),respectively.The D100%and Dmax of the right side of hippocampus of 9F-IMRT-FFF mode plan were significantly lower than those of 9F-IMRT-FF mode plan,with statistically significant(Z=-3.099,-3.260,P<0.05),respectively.The monitor unit(MU)value of 9F-IMRT-FFF mode plan increased by 25%than that of 9F-IMRT-FF mode plan,while the treatment time of 9F-IMRT-FFF mode plan shortened 38%than that of 9F-IMRT-FF mode plan,with statistically significant(t=-9.664,-13.312,P<0.05),respectively.Conclusion:Both the non-uniform 9F-IMRT-FF and the 9F-IMRT-FFF can meet the clinically requirement.The 9F-IMRT-FFF has better modulation capabilities in beams,which has more advantages in reducing the dose of radiotherapy for hippocampus,and reducing treatment time,and increasing treatment efficiency.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the effect of melatonin on the expression of PD-L1 on the surface of ovarian cancer cells.Methods:Ovarian cancer cell line OVCAR3 was treated with melatonin,then flow cytometry was used to detect the expression level of PD-L1 on the surface of ovarian cancer cells.Western blot was used to detect the expressions of PD-L1 and LC-3 in ovarian cancer cells after different treatments.After adding autophagy inhibitor Autophinib,flow cytometry was used to detect the expression of PD-L1 on the surface of ovarian cancer cells,ovarian cancer cells were treated with melatonin or melatonin combined with autophagy inhibi-tors and co-incubated with human T lymphocyte Jurkat.The proportion of ovarian cancer cell apoptosis was detected by flow cytometry.Results:Melatonin treatment significantly reduced expression of PD-L1 on the surface of ovarian cancer cells,promoted autophagy of ovar-ian cancer cells.Autophagy inhibitors reversed down regulation of PD-L1 treated by melatonin,Jurkat cells killed more melatonin treated ovarian cancer cells,and the killing of ovarian cancer cells by Jurkat cells revised by autophagy inhibitors.Conclusion:Mela-tonin can enhance the killing effect of T cells on ovarian cancer cells.

Objective To investigate the efficacy and safety of apatinib combined with capecitabine and temozolomide in the treatment of metastatic gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN).Methods Twenty-eight patients with metastatic GEP-NEN admitted and and treated in this hospital from January 2020 to June 2023 were selected as the study subjects and divided into the experimental group(n=13)and control group(n=15)according to different treatment regimens.The experiment group was given apatinib combined with capecitabine and temozolomide.The control group was given capecitabine and temozo-lomide.The medication lasted until the disease progression(PD)or adverse reactions were intolerable.The main observation indicators were the median progression-free survival(PFS)time.The secondary endpoints included the objective response rate(ORR),disease control rate(DCR)and adverse reactions.Results The experimental group had 0 case of complete remission(CR),6 cases of partial remission(PR),4 cases of stable disease(SD)and 3 cases of PD.ORR and DCR were 46.15％and 76.92％respectively,and the median PFS was 10.8 months.The control group had 0 case of CR,5 cases of PR,4 cases of SD and 6 cases of PD.ORR and DCR were 33.33％and 60.00％respectively,and the median PFS was 9.2 months.PFS in the experiment group was prolonged by 1.6 months than the control group.PD or death risk was decreased by 58％(HR=0.42,95％CI:0.19-0.93,P=0.009 4).The chemotherapeutic drug related adverse reactions in the experimental group occurred,meanwhile the anti-angiogenesis targeting drug related adverse reactions also occurred,but the adverse reactions in the two groups all were grade 1-2,which were tolerated after treatment.Conclusion Apatinib com-bined with capecitabine and temozolomide is effective and safe in the treatment of metastatic GEP-NEN.

Objective:To evaluate the 1-year postoperative efficacy and nutritional indicators of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in obese patients.Methods:This retrospective observational study included patients with a body mass index (BMI) of ≥40.0 kg/m 2 regardless of other related metabolic diseases and patients with severe type 2 diabetes and a BMI between 27.5 and 40.0 kg/m 2. The clinical data of 66 obese patients who underwent SADI-S at the Bariatric and Metabolic Surgery Department of China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were collected, including 53 cases of da Vinci robotic surgery and 13 cases of laparoscopic surgery. The patients comprised 38 men and 28 women with a median age of 35 (18–61) years and a mean preoperative BMI of 42.93 ± 6.82 kg/m 2. A total of 38 patients had type 2 diabetes, and 46 had hyperuricemia, 45 had hypertension, 35 had hyperlipidemia, 12 had hypercholesterolemia, and 12 had a high low-density lipoprotein (LDL) level. The main observation indicators were (1) intraoperative and postoperative conditions; (2) weight loss outcomes, including body weight, BMI, excess body weight loss (%EWL), and total body weight loss (%TWL) at 3, 6, and 12 months after surgery; (3) effects of treatment on metabolic disease; and (4) changes in nutrient indicators. Results:(1) Intraoperative and postoperative conditions: All patients successfully underwent SADI-S with neither conversion to laparotomy nor death. Four (6.1%) patients developed postoperative complications, and all of them recovered and were discharged after conservative or surgical treatment. (2) Weight loss outcomes: %EWL at 3, 6, and 12 months after surgery was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65, respectively, and %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89, respectively. Body weight and BMI 3 to 12 months after surgery were significantly lower than those before surgery (all P < 0.001). (3) Effect of treatment on metabolic disease: 3 to 12 months after surgery, fasting blood sugar, HbA1c, uric acid, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL, and other indicators were significantly lower than those before surgery (all P < 0.05). Twelve months after surgery, the remission rates of diabetes, hyperuricemia, hypertension, hypertriglyceridemia, hypercholesterolemia, and high LDL were 100% (38/38), 65.2% (30/46), 62.2% (28/45), 94.3% (33/35), 100% (12/12), and 100% (12/12), respectively. (4) Changes in nutrient indicators: Compared with the preoperative nutrient levels, the hemoglobin and hematocrit levels were lower at 3 to 12 months after surgery, the total protein level was lower at 6 to 12 months after surgery, the albumin level was lower at 6 months after surgery, and the ferritin level was lower at 3 months after surgery. The differences were statistically significant (all P < 0.05). The incidence of anemia was 6.1% (4/66), hypoalbuminemia was 4.5% (3/66), and ferritin deficiency was 4.5% (3/66), all of which were improved or normalized through conservative treatment. Twelve months after surgery, 30 (45.5%) patients had vitamin A deficiency, 17 (25.8%) had vitamin E deficiency, 11 (16.7%) had folic acid deficiency, 2 had potassium deficiency (3.0%), 3 (4.5%) had calcium deficiency, 2 (3.0%) had magnesium deficiency, 9 (13.6%) had iron deficiency, and 16 (24.2%) had zinc deficiency. However, no relevant clinical symptoms occurred. Conclusions:SADI-S has a very significant effect on weight loss and alleviation of metabolic diseases. Nutrient deficiencies after SADI-S mainly involve vitamin A, vitamin E, zinc, and folic acid. The long-term efficacy and safety of SADI-S still need further follow-up observation.

Objective:To compare single-cell transcriptome sequencing data from skin samples of patients with atopic dermatitis (AD) and those from skin samples of healthy controls, and to investigate immunometabolic characteristics of inflammatory dendritic epidermal cells (IDECs) in skin lesions of patients with AD.Methods:An in-depth analysis was carried out on previously published single-cell sequencing data from 8 AD patients and 7 healthy controls in the Gene Expression Omnibus database (GSE 153760). Marker genes were used to screen out IDECs, and differentially expressed genes in IDECs between the two groups were analyzed. Kyoto Encyclopedia of Genes and Genomes enrichment analysis was performed on these differentially expressed genes, the "AddModuleScore" function in the Seurat package was used to evaluate the IDEC-involved inflammatory and metabolic pathways in the two groups, and Mann-Whitney rank sum test was used for statistical analysis; correlations between the IDEC-involved metabolic and inflammatory pathways were evaluated using the above scores and the "cor" and "cor.test" functions in R packages.Results:A large number of IDECs infiltrating the skin lesions of AD patients highly expressed Th2 chemokines (CCL17), antigen presentation-related genes (CD1B), endothelial growth-related genes (TYMP, AREG), inflammation-related genes (S100A8, S100A10, LGALS1), stromal fibrosis-related genes (MMP12, ADAM19), metabolism-related genes (LDHA, LIPA, GLUL), and danger signaling-related genes (HSPA1B, HSP90AA1, HSPB1, HSPH1). The activities of glucose energy metabolism, glycolytic metabolism, nucleotide metabolism, glutamate and glutamine metabolism, and amino acid metabolism were significantly upregulated in IDECs in AD patients, and were positively correlated with Th2 inflammation levels; the activities of oxidative phosphorylation and lipid metabolism were significantly downregulated in IDECs in AD patients, and the lipid metabolism level was negatively correlated with Th2 inflammation levels. Glutamine metabolism and glucose energy metabolism activities were positively correlated with Th22 inflammation levels; Th1 and Th17 inflammation levels were negatively correlated with the activities of pentose phosphate metabolism, nucleotide metabolism, glycolytic metabolism, and amino acid metabolism pathways.Conclusion:The inflammation- and metabolism-related genes were abnormally expressed in IDECs in skin lesions of AD patients, and activities of multiple metabolic pathways were markedly upregulated in IDECs, among which the glycolysis metabolism activity was mostly correlated with Th2 inflammation levels.

Objective To investigate the expression and significance of matrix metalloproteinases (MMPs) and toll-like receptor 9 (TLR9) in patients with acute leukemia. Methods A total of 44 patients with acute lymphoblastic leukemia (ALL) were enrolled in the ALL group, 30 patients with acute myeloid leukemia (AML) were included in AML group, and 44 healthy individuals undergoing physical examination during the same period were included in the control group. Serum levels of MMP-2, MMP-7, and MMP-9 were measured by enzyme-linked immunosorbent assay (ELISA) in all three groups. The expression of TLR9 mRNA and TLR9 protein in peripheral blood mononuclear cells (PBMCs) was detected by quantitative real-time polymerase chain reaction (qRT-PCR) and western blot, respectively. Spearman's rank correlation analysis was used to explore the correlations of the malignancy of different clinical subtypes of acute leukemia with the expression levels of MMPs and TLR9 protein. Results Serum levels of MMP-2, MMP-7, and MMP-9 were significantly higher in the ALL and AML groups compared to the control group, with the AML group showing higher levels than the ALL group (P < 0.01). The relative expressions of TLR9 mRNA and TLR9 protein in PBMCs in both the ALL and AML groups were significantly lower than those in the control group, and the AML group had lower expression than the ALL group (P < 0.01). Spearman's rank correlation analysis revealed positive correlations of serum levels of MMP-2, MMP-7, and MMP-9 with the malignancy of both ALL and AML (P < 0.05), while the relative expression of TLR9 protein was negatively correlated with the malignancy of both ALL and AML (P < 0.05). Conclusion Serum levels of MMP-2, MMP-7, and MMP-9 are significantly elevated in patients with acute leukemia, while TLR9 expression is significantly reduced in PBMCs. The abnormal overexpression of MMPs may promote extramedullary infiltration and immune escape of acute leukemia cells by inhibiting TLR9 expression, thereby accelerating the malignant progression of the tumor.

Objective To investigate the effects of atorvastatin calcium on thyroid function, immune response and C-Jun N-terminal kinase/p38 mitogen-activated protein kinase (JNK/p38 MAPK) signaling pathway in rats with hypothyroidism. Methods A total of 30 healthy adult male SD rats were randomly divided into control group, hypothyroid group (PTU group) and atorvastatin calcium treatment group (ACT group), with 10 rats in each group. Rats in the PTU group and the ACT group were injected with PTU subcutaneously at the dorsum of the neck every day for 28 consecutive days; instead of PTU, rats in the control group were injected subcutaneously with 0.3 mL of saline. After 2 weeks of PTU treatment, rats in the ACT group were gavaged with 3 mL of atorvastatin calcium saline solution (containing 5 mg/kg of atorvastatin calcium), which was administered once daily; the control group was gavaged with an equal amount of saline in the same way. The body weight, food intake and water intake of rats were measured weekly. The histopathological changes of the thyroid gland were observed in histopathological sections of rats in each group. Enzyme-linked immunosorbent assay (ELISA) was performed to determine the levels of triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), interferon γ (IFN-γ) and interleukin-4 (IL-4) in serum; quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) was performed to detect the mRNA expression levels of IFN-γ, IL-10, Foxp3 and IL-4; western blot was performed to determine the levels of p-JNK/JNK and p-p38/p38 MAPK. Results Compared with control group, PTU-induced hypothyroidism rats showed a significant decrease in body mass and food and water consumption (P < 0.05). After 2 weeks of treatment with atorvastatin calcium, the body mass loss of PTU rats was inhibited, food and water consumption was improved, and the differences were statistically significant (P < 0.05). Atorvastatin calcium was able to significantly increase the serum T3 and T4 levels and decrease the serum TSH level in hypothyroid rats (P < 0.05). Atorvastatin calcium treatment was able to significantly alleviate histopathological changes such as follicular cell proliferation and related hypertrophy induced by PTU, and increase follicular size (P < 0.05). After treatment with atorvastatin calcium, the spleen mass of PTU rats increased significantly, and the expression of IFN-γ mRNA in hypothyroid rats decreased significantly, but the expression levels of IL-10 mRNA, Foxp3 mRNA and IL-4 mRNA increased significantly (P < 0.05). After treatment with atorvastatin calcium, the levels of p-JNK/JNK and p-p38/p38 MAPK in thyroid tissue of hypothyroid rats decreased significantly (P < 0.05). Conclusion Atorvastatin calcium treatment for hypothyroidism has the function of promoting the normalization of thyroid hormone imbalance, balancing Th1/Th2 cytokines, and inhibiting the activation of JNK/p38 MAPK signaling pathway.