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Background Cardiometabolic index (CMI) is an index integrating visceral obesity and dyslipidemia. This study intends to scrutinize the connection between CMI and gallstone disease (GSD) and to elucidate the association between CMI and insulin resistance (IR) in patients with GSD. Methods To explore the potential nonlinear association and determine the inflection point, a restricted cubic spline (RCS) analysis was performed. Following categorization of CMI based on the identified inflection point, multivariate logistic regression models, subgroup analyses, and interaction tests were utilized to assess the connection between CMI and GSD, as well as between CMI and IR in GSD patients. The homeostasis model assessment for IR (HOMA-IR) and triglyceride-glucose (TyG) index was applied to evaluate IR. Spearman analysis was implemented to investigate the connection between CMI and HOMA-IR. The predictive performance of each indicator was evaluated by the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results The study included 2311 individuals, with a GSD prevalence of 10.90%. RCS analysis revealed a nonlinear positive correlation between CMI and GSD (nonlinear P  < 0.001), as well as between CMI and IR (nonlinear P <  0.001). In the fully adjusted multivariable logistic regression analysis of covariates, compared with the low-category CMI group, the high-category CMI was significantly associated with the risk of GSD (OR = 1.547, 95% CI: 1.143–2.092, P  = 0.005), IR (OR = 4.990, 95% CI: 2.517–9.892, P  < 0.001). Subgroup analysis demonstrated that the correlation between CMI and GSD was stronger in females. Spearman correlation analysis showed a positive association between CMI and HOMA-IR in GSD patients ( r  = 0.548, P  < 0.001). The ROC curve demonstrated the predictive performance of the CMI model for GSD (AUC = 0.743), which was superior to conventional indicators such as Body Mass Index and Waist Circumference; the predictive performance of CMI (AUC = 0.772) for IR was consistent with that of TyG (AUC = 0.772). Conclusion Our research demonstrates that CMI exhibits a nonlinear positive correlation with the incidence of GSD and IR. This suggests that CMI may serve as a novel and valuable indicator for further investigating the intricate relationships among metabolic syndrome, obesity, and GSD.

Numerous plants of medicinal value grow on Hainan Island (China). Given the lack of knowledge on the phytochemical and pharmacological properties of Michelia shiluensis Chun and Y. F. Wu (M. shiluensis), the application of natural antioxidants and antimicrobials in the food industry has attracted increasing interest. This study aimed to compare the chemical composition, free-radical-scavenging capacity, and antibiosis of aqueous extracts of the fresh and dried leaves of M. shiluensis. The aqueous extract of the leaves of M. shiluensis was obtained using steam distillation, and its chemical components were separated and identified via gas chromatography–mass spectrometry (GC-MS). The free-radical-scavenging capacity and antibiosis were determined. Further, 28 and 20 compounds were isolated from the fresh leaf aqueous extract of M. shiluensis (MSFLAE) and dried leaf aqueous extract of M. shiluensis (MSDLAE), respectively. The free-radical-scavenging capacity of MSFLAE and MSDLAE was determined by the 2,2-diphenyl-1 picrylhydrazyl (DPPH) method, which was 43.43% and 38.74%, respectively. The scavenging capacity of MSFLAE and MSDLAE determined by the 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonate (ABTS)) method was 46.90% and 25.99%, respectively. The iron ion reduction capacity of MSFLAE and MSDLAE was determined by the ferric-reducing antioxidant power (FRAP) method as 94.7 and 62.9 μmol Fe2⁺/L, respectively. This indicated that the two leaf aqueous extracts had a certain free-radical-scavenging capacity, and the capacity of MSFLAE was higher than that of MSDLAE. The antibiosis of the two leaf aqueous extracts on the three foodborne pathogenic bacteria was low, but the antimicrobial effects on Gram-positive bacteria were better than those on Gram-negative bacteria. The antibiosis of MSFLAE on Escherichia coli and Staphylococcus aureus was greater than that of MSDLAE. Finally, MSFLAE and MSDLAE both had certain free-radical-scavenging capacities and antibiosis, confirming that the use of this plant in the research and development of natural antioxidants and antibacterial agents was reasonable. Plant aqueous extracts are an essential source of related phytochemistry and have immense pharmacological potential.

F-P (Fabry–Perot) pressure sensors have a wide range of potential applications in high-temperature, high-pressure, and high-dynamic environments. However, existing demodulation methods commonly rely on spectrometers, which limits their application to high-frequency pressure signal acquisition. To solve this problem, this study developed a self-compensated, three-wavelength demodulation system composite with an F-P pressure sensor and a thermocouple to construct a comprehensive sensing system. The system produces accurate pressure measurements in high-temperature, high-pressure, and high-dynamic environments. In static testing at room temperature, the sensing system shows excellent linearity, and the pressure sensitivity is 158.48 nm/MPa. In high-temperature testing, the sensing system maintains high linearity in the range of 100 °C to 700 °C, with a maximum pressure-indication error of about 0.13 MPa (0~5 MPa). In dynamic testing, the sensor exhibits good response characteristics at 1000 Hz and 5000 Hz sinusoidal pressure frequencies, with a signal-to-noise ratio (SNR) greater than 37 dB and 45 dB, respectively. These results indicate that the sensing system proposed in this study has significant competitive advantages in the field of high-temperature, high-speed, and high-precision pressure measurements and provides an important experimental basis and theoretical support for technological progress in related fields.

Objective The incidence of open reduction and internal fixation (ORIF) in flexion-type supracondylar humerus fractures (SCHF) in children is significantly higher than that of extension-type fractures. This study aimed to identify risk factors for ORIF in flexion-type SCHF. Methods One hundred seventy-one patients with Wilkins type III flexion-type SCHF from January 2012 to December 2021 were retrospectively enrolled in a tertiary paediatric hospital. Patients were divided into ORIF group versus closed reduction and internal fixation (CRIF) group. Then, patients data of age, sex, injury side, obesity, deviation of displacement, fracture level, rotation, nerve injury, and delay from injury to surgery were reviewed. Univariate analysis and multivariate logistic regression were used to identify independent risk factors and odds ratios (OR) of ORIF. Results Overall, 171 children with type III flexion-type SCHF were analyzed (average aged 7.9 ± 2.8 years). Displacement was lateral in 151 cases, medial in 20. 20 cases had combined ulnar nerve injury. The failed closed reduction rate was 20%. Univariate analysis indicated age, distal fracture fragment rotation, and ulnar nerve injury were significantly associated with ORIF. ( P  = 0.047, P  = 0.009, and P  = 0.001, respectively). Multivariate logistic regression analysis showed that distal fracture fragment rotation (OR, 3.3; 95%CI:1.1–9.5; P  = 0.028) and ulnar nerve injury (OR, 6.4; 95%CI:2.3–18.3; P  = 0.001) were independent risk factors; however, the age was not an independent one (OR, 1.5; 95%CI:0.6–3.5; P  = 0.397) for ORIF in the Wilkins type III flexion-type SCHF. Conclusion Distal fracture fragment malrotation on initial x-rays and ulnar nerve injury were significant risk factors for ORIF in Wilkins type III flexion-type SCHF. Surgeons should prepare tourniquets or other open reduction instruments when treating these types of fractures. Level of evidence Level IV

Purpose To assess the impact of endoscope-assisted fractured roots or fragments extraction within the mandibular canal, along with quantitative sensory testing (QST) alterations in the inferior alveolar nerve (IAN). Methods Six patients with lower lip numbness following mandibular third molar extraction were selected. All patients had broken roots or fragments within the mandibular canal that were extracted under real-time endoscopic assistance. Follow-up assessments were conducted on postoperative days 1, 7, and 35, including a standardized QST of the lower lip skin. Results The average surgical duration was 32.5 min, with the IAN exposed in all cases. Two of the patient exhibited complete recovery of lower lip numbness, three experienced symptom improvement, and one patient remained unaffected 35 days after the surgery. Preoperative QST results showed that the mechanical detection and pain thresholds on the affected side were significantly higher than those on the healthy side, but improved significantly by postoperative day 7 in five patients, and returned to baseline in two patients on day 35. There were no significant differences in the remaining QST parameters. Conclusions All endoscopic surgical procedures were successfully completed without any additional postoperative complications. There were no cases of deterioration of IAN injury, and lower lip numbness recovered in the majority of cases. Endoscopy allowed direct visualization and examination of the affected nerve, facilitating a comprehensive analysis of the IAN.

Spring snowmelt has a significant impact on the hydrological cycle in seasonally frozen soil areas. However, scholars hold differing, and even opposing, views on the role of snowmelt during the thawing period in groundwater recharge. To explore the potential recharge effects of spring snowmelt on groundwater in seasonal frozen soil areas, this study investigated the vadose zone dynamics controlled by soil freeze–thaw processes and snowmelt infiltration in the Northeast of China for 194 days from 31 October 2020 to 12 May 2021. Responses of groundwater level and soil moisture to snowmelt infiltration show that most snowmelt was infiltrated under the site despite the ground being frozen. During the unstable thawing period, surface snow had already melted, and preferential flow in frozen soil enabled the recharge groundwater by snowmelt (rainfall), resulting in a significant rise in groundwater levels within a short time. The calculated and simulated snowmelt (rainfall) infiltration coefficient revealed that during the spring snowmelt period, the recharge capacity of snowmelt or rainfall to groundwater at the site is 3.2 times during the stable thawing period and 4.5 times during the non-freezing period.

Background Although immune checkpoint inhibitors (ICIs) have brought survival benefits to non-small cell lung cancer (NSCLC), disease progression still occurs, and there is no consensus on the treatment options for these patients. We designed a network meta-analysis (NMA) to evaluate systemic treatment options for NSCLC after failure of ICIs. Methods PubMed, Embase, Web of Science and Cochrane Library databases were searched, then literature screening was followed by NMA. We included all Phase II and III randomized controlled trials (RCTs). Progression-free survival (PFS) and overall survival (OS) used hazard ratio (HR) for evaluation. Objective response rate (ORR) and adverse events (AEs) used odds ratio (OR) and relative risk (RR) effect sizes, respectively. R software was applied to compare the Bayesian NMA results. Results We finally included 6 studies. 1322 patients received ICI plus Chemotherapy (ICI + Chemo), ICI plus Anti-angiogenic monoclonal antibody (ICI + Antiangio-Ab), ICI plus Tyrosine kinase inhibitor (ICI + TKI), Tyrosine kinase inhibitor plus Chemotherapy (TKI + Chemo), Standard of Care (SOC), Chemotherapy (Chemo). TKI + Chemo is associated with longer PFS, higher ORR (surface under cumulative ranking curve [SUCRA], 99.7%, 88.2%), ICI + TKI achieved the longest OS (SUCRA, 82.7%). ICI + Antiangio-Ab was granted the highest safety rating for adverse events (AEs) of any grade, AEs greater than or equal to grade 3 and AEs of any grade leading to discontinuation of treatment (SUCRA, 95%, 82%, 93%). Conclusions For NSCLC after failure of ICIs, TKI + Chemo was associated with longer PFS and higher ORR, while ICI + TKI was associated with the longest OS. In terms of safety, ICI + Antiangio-Ab was the highest.

Background Management of distal humerus metaphyseal-diaphyseal junction (MDJ) region fractures can be very challenging mainly because of the higher location and characteristics of the fracture lines. Loss of reduction is relatively higher in MDJ fractures treated with classical supracondylar humerus fractures (SHFs) fixation techniques. Methods Three different fracture patterns including transverse, medial oblique and lateral oblique fractures were computationally simulated in the coronal plane in the distal MDJ region of a pediatric humerus and fixated with Kirschner Wires (K-wires), elastic stable intramedullary nails (ESIN), and lateral external fixation system (EF). Stiffness values in flexion, extension, valgus, varus, internal, and external rotations for each fixation technique were calculated. Results In the transverse fracture model, 3C (1-medial, 2-lateral K-wires) had the best stiffness in flexion, varus, internal, and external rotations, while 3L (3-divergent lateral K-wires) was the most stable in extension and valgus. In the medial oblique fracture model, EF had the best stiffness in flexion, extension, valgus, and varus loadings, while the best stiffness in internal and external rotations was generated by 3MC (2-medial, 1-lateral K-wires). In the lateral oblique fracture model, 3C (1-medial, 2-lateral K-wires) had the best stiffness in flexion and internal and external rotations, while ESIN had the best stiffness in extension and valgus and varus loadings. Conclusion The best stability against translational forces in lateral oblique, medial oblique, and transverse MDJ fractures would be provided by ESIN, EF, and K-wires, respectively. K-wires are however superior to both ESIN and EF in stabilizing all three fracture types against torsional forces, with both 2-crossed and 3-crossed K-wires having comparable stability. Depending on the fracture pattern, a 3-crossed configuration with either 2-divergent lateral and 1-medial K-wires or 2-medial and 1-lateral K-wires may offer the best stability.

Objectives This study aims to evaluate the accuracy of cone beam computed tomography (CBCT) in predicting the exposure of inferior alveolar nerve (IAN) during complicated mandibular third molars (M3M) extraction. Methods 115 M3Ms with canal cortical defect signs on preoperative CBCT were extracted. Candidate variables included sex, age, types of CBCT machine, the Winter classification of M3Ms, the size of root entering the canal on CBCT, the size of cortical defect on CBCT. The primary outcome was the exposure of IAN and the exposed neurovascular bundle size which was recorded measured under endoscope. The independent sample t-test, Bland-Altman analysis was performed to assess the agreement between the CBCT and endoscopic measurements. The regression analysis was performed to determine if there was a correlation between the measurements of CBCT and endoscope. The Chi-square test was used to evaluate whether the proportion of IAN exposure in different impacted M3M types were consistent. ANOVA was used to test the correlation between the actual size of exposed IAN and (1) Winter classification types; (2) types of CBCT machine. Results 85/115 (73.9%) M3Ms with canal cortical defect signs on preoperative CBCT had intraoperative exposure of IAN. The average length and width of the exposed IAN were 5.89 ± 1.72 mm and 2.48 ± 0.79 mm, which were significantly smaller than the size of root entering the canal on CBCT (9.69 ± 3.05 mm and 3.26 ± 0.87 mm, P  < 0.001) but larger than the cortical defect size (5.06 ± 2.05 mm and 2.10 ± 0.54 mm, P  < 0.05). The regression analysis showed that IAN exposure was significantly associated with the cortical defect length (0.1 mm) on CBCT (OR = 1.38, P  = 0.001). The probability of intraoperative IAN exposure was statistically different among different Winter classifications of M3M and the probability of IAN exposure was higher in non-horizontal impacted type according to Chi-square test results. ANOVA showed statistical difference between exposed IAN length and Winter classification types ( p  = 0.001). Conclusions Not all M3Ms with tooth-IAN contact signs on preoperative CBCT indicated intraoperative IAN exposure. The size of root entering the canal on CBCT were mostly larger than the intraoperative endoscopic measurements. IAN exposure can be accurately predicted by the length of cortical defect on CBCT. Non-horizontal impaction predisposed the M3M to a higher risk of intraoperative IAN exposure. Clinical relevance Endoscope provides the possibility to observe and record the IAN exposure directly. IAN exposure can be accurately predicted by the length of cortical defect instead of the size of root entering the canal on CBCT. Non-horizontal impaction predisposed the M3M to a higher risk of intraoperative IAN exposure. Clinical trial number Not applicable

Background To analyze and summarize the clinical efficacy of mucoperiosteal flap combined with perforation technique for tooth extraction in medication-related osteonecrosis of the jaw risk (MRONJ) population, and to provide clinical treatment options for such patients. Methods This study included 51 patients receiving antiresorptive drug (ARD) treatment who underwent tooth extraction at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology between November 2016 and February 2024. Preoperative clinical data were collected and analyzed. Based on their drug history, patients were categorized into two groups: (1) low-dose ARD group for patients with non-neoplastic lesion like osteoporosis (LDA), (2) high-dose ARD group for patients with bone metastatic lesions like breast cancer (HDA). All patients underwent tooth extraction using mucoperiosteal flap combined with perforation technique. Follow-up assessments were conducted at 1 week, 2 weeks, 1 month, 3 month and 6 months postoperatively. The primary evaluation outcome was whether the patient had developed MRONJ at the extraction site at 6 months. The secondary evaluation outcome was whether the extraction socket mucosa healed completely within 1 month. Statistical analysis included Chi-square, Fisher’s exact, Mann–Whitney U/t tests and survival analysis to contrast between LDA and HDA group. Significance was set at p  ≤ 0.05. Results A total of 82 extraction sites in 51 patients (31 females in LDA group with a mean age of 66.58 ± 13.29 years. 14 females and 6 males in HDA group with a mean age of 58.24 ± 11.63 years) were included in the study. Of these, 47 extraction sites in the LDA group, 35 extraction sites in the HDA group. During postoperative follow-up, MRONJ only occurred in 2 extraction sites in HDA group in two patients, resulting in a postoperative clinical healing rate of 100% (47/47) in LDA group and 94.3% (33/35) in HDA group. A significant difference in the time to extraction socket mucosal healing was observed between the LDA and HDA groups ( p  ≤ 0.05). Conclusions This study demonstrated that in patients with potential risks of MRONJ, the application of mucoperiosteal flap combined with perforation technique based teeth extraction method could safely and effectively alleviate the dental inflammation in the oral cavity, and mitigates the risk of MRONJ development.