Objective To explore the application of plasma 7 microRNA (miR7) testing in the differential diagnosis of very early-stage hepatocellular carcinoma (HCC). Methods This study is a multicenter real-world study. Patients with single hepatic lesion (maximum diameter≤2 cm) who underwent plasma miR7 testing at Zhongshan Hospital, Fudan University, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Anhui Provincial Hospital, and Peking University People’s Hospital between January 2019 and December 2024 were retrospectively enrolled. Patients were divided into very early-stage HCC group and non-HCC group, and the clinical pathological characteristics of the two groups were compared. The value of plasma miR7 levels, alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (DCP) in the differential diagnosis of very early-stage HCC was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). In patients with both negative AFP and DCP (AFP＜20 ng/mL, DCP＜40 mAU/mL), the diagnostic value of plasma miR7 for very early-stage HCC was analyzed. Results A total of 64 528 patients from 4 hospitals underwent miR7 testing, and 1 682 were finally included, of which 1 073 were diagnosed with very early-stage HCC and 609 were diagnosed with non-HCC. The positive rate of miR7 in HCC patients was significantly higher than that in non-HCC patients (67.9% vs 24.3%, P＜0.001). ROC curves showed that the AUCs for miR7, AFP, and DCP in distinguishing HCC patients from the non-HCC individuals were 0.718, 0.682, and 0.642, respectively. The sensitivities were 67.85%, 43.71%, and 44.45%, and the specificities were 75.70%, 92.78%, and 83.91%, respectively. The pairwise comparison of AUCs showed that the diagnostic efficacy of plasma miR7 detection was significantly better than that of AFP or DCP (P＜0.05). Although its specificity was slightly lower than AFP and DCP, the sensitivity was significantly higher. Among patients negative for both AFP and DCP, miR7 maintained an AUC of 0.728 for diagnosing very early-stage HCC, with 67.82% sensitivity and 77.73% specificity. Conclusions Plasma miR7 testing is a potential molecular marker with high sensitivity and specificity for the differential diagnosis of small hepatic nodules. In patients with very early-stage HCC lacking effective molecular markers (negative for both AFP and DCP), miR7 can serve as a novel and effective molecular marker to assist diagnosis.

OBJECTIVE: Paridis Rhizoma (Chonglou in Chinese), a traditional Chinese herbal medicine, has been shown have strong anti-tumor effects. Paris saponin VII (PSVII), an active constituent isolated from Paridis Rhizoma, was demonstrated to significantly suppress the proliferation of BxPC-3 cells in our previous study. Here, we aimed to elucidate the anti-pancreatic ductal adenocarcinoma (PDAC) effect of PSVII and the underlying mechanism. METHODS: Cell viability was determined by CCK-8, colony formation, and cell migration assays. Cell apoptosis and reactive oxygen species (ROS) production were measured by flow cytometry with annexin V/propidine iodide (Annexin V/PI) and 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA), respectively. Pyroptosis was evaluated by morphological features, Hoechst 33342/PI staining assay, and release of lactate dehydrogenase (LDH). JC-1 fluorescent dye was employed to measure mitochondrial membrane potential. Western blotting and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) were used to determine the levels of proteins or mRNAs. The effect in vivo was assessed by a xenograft tumor model. RESULTS: PSVII inhibited the viability of PDAC cells (BxPC-3, PANC-1, and Capan-2 cells) and induced gasdermin E (GSDME) cleavage, as well as the simultaneous cleavage of Caspase-3 and poly (ADP-ribose) polymerase 1 (PARP). Knockdown of GSDME shifted PSVII-induced pyroptosis to apoptosis. Additionally, the effect of PSVII was significantly attenuated by Z-Asp(OMe)-Glu(OMe)-Val-Asp(OMe)-fluoromethylketone (Z-DEVD-FMK), on the induction of GSDME-dependent pyroptosis. PSVII also elevated intracellular ROS accumulation and stimulated Bax and Caspase-3/GSDME to conduct pyroptosis in PDAC cells. The ROS scavenger N-acetyl cysteine (NAC) suppressed the release of LDH and inhibited Caspase-9, Caspase-3, and GSDME cleavage in PDAC cells, ultimately reversing PSVII-induced pyroptosis. Furthermore, in a xenograft tumor model, PSVII markedly suppressed the growth of PDAC tumors and induced pyroptosis. CONCLUSION These results demonstrated that PSVII exerts therapeutic effects through Caspase-3/GSDME-dependent pyroptosis and may constitute a novel strategy for preventing chemotherapeutic resistance in patients with PDAC in the future.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment.However,irrigant selection or irrigation procedures are far from clear.The vapor lock effect in the apical region has yet to be solved,impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.Additionally,ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified.Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes.Indeed,clinicians have been aware of these concerns for years.Based on the current evidence of studies,this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions.The evolution of different kinetic irrigation methods,their effects,limitations,the paradigm shift,current indications,and effective operational procedures regarding intracanal medication are also discussed.This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication,thus facilitating a better understanding of infection control,standardizing clinical practice,and ultimately improving the success of endodontic therapy.

Objective To analyze the characteristics and rules of 65 cases of medical compensation for neonatal brain damage,and put forward countermeasures and suggestions to provide reference for improving obstetric diagnosis and treatment.Methods Using neonatal brain damage as the key word,the judgment documents published on China Judgments Online from June 2021 to June 2023 were retrieved.the data database was established with Excel,and the basic situation of the case,disability grade and appraisal opinions were statistically analyzed.Results A total of 79 cases of relevant judgment documents were retrieved,and 65 cases were included in the judgment documents,of which 90.77%occurred in the last 10 years(2011-2020).38.46%,15.38%and 46.16%occurred on Saturday to Sunday,Friday and Monday to Thursday,respectively.The proportion of medical institutions being judged by the court to bear 50%or more of the responsibility was 49.23%,and the proportion of less than 50%was 50.77%;The proportions of compensation amount of 1 million yuan and above,500,000-990,000 yuan,100,000-490,000 yuan and less than 90,000 yuan were 18.46%,12.31%,49.23%and 20.00%respectively.The main causes of responsibility were improper medical and,nursing techniques,negligence of medical staff,out-of-range diagnosis and treatment,defects in meidcal record keeping,insufficient risk notification,and other factors,which were 29.23%,20%,7.69%,9.23%,13.85%and 20%,respectively.The incidence rates in tertiary hospitals,secondary hospitals,primary hospitals or township hospitals and community hospitals were 52.31%,41.54%and 6.15%,respectively.The proportion of first degree disability,second degree disability,third degree and above disability and unknown grade of newborn were 18.46%,18.46%,21.54%and 41.54%,respectively.Conclusion The disability level of newborn brain damage compensation cases is relatively serious,which highlights the problems such as unreasonable allocation of obstetric medical resources,"obstetric weekend effect",insufficient implementation of obstetric diagnosis and treatment norms,and weak legal awareness of medical staff.Therefore,it is necessary to strengthen the prevention and treatment of neonatal brain damage in view of the above problems,reduce the occurrence of incidents,and help establish a harmonious doctor-patient relationship.

Objective:To understand the factors hindering exercise rehabilitation in aged patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) and provide a reference for clinical interventions.Methods:Aged CHD patients who underwent PCI in the Department of Cardiovascular Medicine at Hunan Provincial People's Hospital from January to June 2022 were selected by purposive sampling and underwent semi-structured interviews. Content analysis was employed for data analysis.Results:The factors hindering exercise rehabilitation in aged CHD patients after PCI can be categorized into two major groups: endogenous factors and exogenous factors. Endogenous factors were categorized into four themes: inadequate understanding, adverse disease experiences, weakness and physical dysfunction, and poor self-perception. Exogenous factors were categorized into four themes: lack of cardiac rehabilitation prescriptions and programs, social environmental barriers, insufficient family support, and restricted medical insurance coverage.Conclusions:The factors hindering exercise rehabilitation in aged CHD patients after PCI are diverse and complex. Prior to implementing exercise rehabilitation, healthcare professionals should thoroughly assess individuals' health conditions, rehabilitation needs, and limiting factors, and provide feasible rehabilitation content and formats.

Objective To retrieve, evaluate and integrate evidences for the prevention of urinary sepsis in patients with nephrostomy tube indwelling. Methods Relevant literatures were searched according to the "6S" evidence-based pyramid model, and the retrieval time was from the establishment of the database to August 2023. Two team members independently evaluated the quality of various literatures. The data extraction was performed for the literatures meeting the criteria, and the evidences were graded. Results A total of 11 articles were finally included, including 1 evidence summary, 4 guidelines, 2 systematic reviews, and 4 expert consensuses. Eighteen evidences for the prevention of urosepsis in patients with nephrostomy tubes were summarized, including five topics: evaluation of indwelling time, selection of nephrostomy tubes, indwelling duration, prevention and nursing of complications and extubation timing. Conclusion This study summarizes evidences for the prevention of urosepsis in patients with nephrostomy tubes, which can provide clinicians with evidence-based nursing basis and reference for scientific nursing of nephrostomy tubes.

In 2016, a national one million general population cohort project was set up in China for the first time in "Precision Medicine Research" Key Project, National Key Research and Development Program of China, which consists of general population cohorts in seven areas in China. As one of the seven major areas in China, northeastern China has unique climate and specific dietary patterns, and population aging is serious in this area. And the burden of chronic and non-communicable diseases ranks tops in China. Therefore, it is of great significance to establish a large general population cohort in northeastern China to explore the area specific exposure factors related to pathogenesis and prognosis of chronic and non-communicable diseases, develop new prevention strategies to reduce the burden of the diseases and improve the population health in northeastern China. In July 2018, the general population cohort study in northeastern China was launched, the study includes questionnaire survey, health examination and blood, urine and stool sample collection and detection in recruited participants. By now, the cohort has covered all age groups, and the baseline data of 115 414 persons have been collected. This paper summarizes the design and practice of the general population cohort study in northeastern China to provide reference for related research in China.

Objective:To explore the perception and demand of children's parents on Internet children's hospital, and provide reference for improving the service model of Internet children's hospitals.Methods:This is a qualitative study. Totally 11 parents of children who visited the outpatient services of Guangzhou Women and Children's Medical Center from November to December 2021 were selected by convenience sampling, and a semi-structured interview was conducted with them based on a self-made outline. The Colaizzi phenomenological 7-step analysis method was used to analyze the data and refine the themes.Results:A total of four themes were extracted, namely, the high degree of parental recognition of the Internet children's hospital service model, the need for convenient, timely and safe information acquisition, the need for professional, reliable and friendly diagnosis and treatment services, and the need for reasonable and transparent fees.Conclusions:The online diagnosis and treatment services of Internet children's hospitals meet the needs of parents for medical treatment and have good prospects. At the same time, the service model of Internet children's hospitals should pay more attention to the convenience, professionalism, safety and economy of users, so as to promote its healthy development.

Objective:To investigate the prevalence of anxiety and depression in patients undergoing thoracic tumor radiotherapy, preliminarily evaluate the nutritional risk of patients, and analyze the possible influential factors of anxiety and depression and their correlation with nutritional risk, providing a theoretical basis for further formulating a personalized psychological nursing plan for patients undergoing thoracic tumor radiotherapy.Methods:A total of 121 patients who underwent thoracic tumor radiotherapy between April 2019 and March 2020 in Cancer Hospital of The University of Chinese Academy of Sciences were selected for this study. We evaluated patients' psychological statuses using the Hospital Anxiety and Depression Scale and patients' nutritional risk using the Nutrition Risk Screening. We performed univariate analysis, unconditional logistic regression analysis, and contingency analysis to analyze the factors that affected the psychological status of patients undergoing thoracic tumor radiotherapy and correlate patients' psychological status with nutritional risk.Results:Among 121 patients, 99 (81.8%) patients undergoing thoracic tumor radiotherapy would develop or had developed anxiety, and 42 (34.7%) patients were at the boundary of depression or had depression. Correlation analysis revealed that nutritional risk was correlated with the prevalence of anxiety and depression. Logistic regression analysis showed that surgery, first radiotherapy, and nutritional risk were the factors that affected the prevalence of anxiety. Marital status, location of tumors, surgery, first radiotherapy, and nutritional risk affected the prevalence of depression.Conclusion:Patients undergoing thoracic tumor radiotherapy have serious psychological problems. Nutritional risk is positively correlated with the prevalence of anxiety and depression. Surgery and first radiotherapy are the factors that affect the prevalence of anxiety and depression.

Regenerative endodontic procedures (REPs) is a biologic-based treatment modality for immature permanent teeth diagnosed with pulp necrosis. The ultimate objective of REPs is to regenerate the pulp-dentin complex, extend the tooth longevity and restore the normal function. Scientific evidence has demonstrated the efficacy of REPs in promotion of root development through case reports, case series, cohort studies, and randomized controlled studies. However, variations in clinical protocols for REPs exist due to the empirical nature of the original protocols and rapid advancements in the research field of regenerative endodontics. The heterogeneity in protocols may cause confusion among dental practitioners, thus guidelines and considerations of REPs should be explicated. This expert consensus mainly discusses the biological foundation, the available clinical protocols and current status of REPs in treating immature teeth with pulp necrosis, as well as the main complications of this treatment, aiming at refining the clinical management of REPs in accordance with the progress of basic researches and clinical studies, suggesting REPs may become a more consistently evidence-based option in dental treatment.
Humans ; Consensus ; Regenerative Endodontics ; Dental Pulp Necrosis/therapy* ; Dentists ; Professional Role ; Dental Care