BACKGROUND:The mechanisms underlying the occurrence of pressure injuries are complex,and it is not entirely clear which factors play a central role in the development of pressure injuries and how these factors operate. OBJECTIVE:To investigate the relationship between Piezo-type mechanosensitive ion channel component 1(Piezo1)and the occurrence of pressure injuries. METHODS:(1)Cellular experiment:Human immortalized keratinocytes(HaCaT)were treated with Yoda1,a Piezo1 agonist,at different concentrations.Cell viability,calcium ion influx,Piezo1,and apoptosis-related protein expression were detected.(2)Animal experiment:Twelve Sprague-Dawley rats were randomly divided into a control group and three experimental groups,with three rats in each group.The control group was not subjected to pressure,while in the three experimental groups,magnets with a thickness of 1,2,and 3 mm were used to press on both sides of the rats'back for 1 hour,respectively,to establish the animal models of pressure injuries.After modeling,all traumatic tissues were excised and subjected to hematoxylin-eosin,Masson,immunofluorescence staining and western blot assay. RESULTS AND CONCLUSION:Cellular experiments:The results of live/dead cell staining showed that HaCaT cell apoptosis increased with the increase of Yoda1 concentration(0,2.5,5,and 10 μmol/L),and calcium ion influx increased with the increase of Yoda1 concentration(0,5,and 10 μmol/L),as well as with the prolongation of treatment time.Western blot assay results showed an increase in the expression of BAX,TG2,and PIEZO1 and a decrease in the expression of the expression of Bcl-2 protein in HaCaT cells in 5 and 10 μmol/L Yoda1 groups compared with the control group(0 μmol/L Yoda1).Animal experiments:The results of hematoxylin-eosin and Masson staining showed that the skin structure of the three experimental groups was damaged at the compression site,there was subcutaneous fat liquefaction and necrosis,and collagen was sparse and disorganized,and damage to the skin structure at the compression site was aggravated with the increase of magnet thickness.Immunofluorescence staining and western blot results showed that compared with the control group,the expression of BAX,TG2,Yap1 and PIEZO1 proteins was elevated,and the expression of Bcl-2 proteins was lowered in the three experimental groups.Moreover,the expression of related proteins showed more significant changes with the increase of magnet thickness(pressure).To conclude,skin compression activates PIEZO1,leading to a significant influx of calcium ions.As the pressure increases,this ultimately results in cell apoptosis due to calcium overload.

BACKGROUND:In recent years,deep learning technologies have been increasingly applied in the field of oral medicine,enhancing the efficiency and accuracy of oral imaging analysis and promoting the rapid development of intelligent oral medicine. OBJECTIVE:To elaborate the current research status,advantages,and limitations of deep learning based on oral imaging in the diagnosis and treatment decision-making of oral diseases,as well as future prospects,exploring new directions for the transformation of oral medicine under the backdrop of deep learning technology. METHODS:PubMed was searched for literature related to deep learning in oral medical imaging published from January 2017 to January 2024 with the search terms"deep learning,artificial intelligence,stomatology,oral medical imaging."According to the inclusion criteria,80 papers were finally included for review. RESULTS AND CONCLUSION:(1)Classic deep learning models include artificial neural networks,convolutional neural networks,recurrent neural networks,and generative adversarial networks.Scholars have used these models in competitive or cooperative forms to achieve more efficient interpretation of oral medical images.(2)In the field of oral medicine,the diagnosis of diseases and the formulation of treatment plans largely depend on the interpretation of medical imaging data.Deep learning technology,with its strong image processing capabilities,aids in the diagnosis of diseases such as dental caries,periapical periodontitis,vertical root fractures,periodontal disease,and jaw cysts,as well as preoperative assessments for procedures such as third molar extraction and cervical lymph node dissection,helping clinicians improve the accuracy and efficiency of decision-making.(3)Although deep learning is promising as an important auxiliary tool for the diagnosis and treatment of oral diseases,it still has certain limitations in model technology,safety ethics,and legal regulation.Future research should focus on demonstrating the scalability,robustness,and clinical practicality of deep learning,and finding the best way to integrate automated deep learning decision support systems into routine clinical workflows.

OBJECTIVE To analyze the blood components of Suanzaoren Decoction after oral administration using UHPLC-Q Exactive Orbitrap-MS technology.METHODS Female Sprague-Dawley(SD)rats were used as experimental subjects,and Suanza-oren Decoction was administered orally.Serum samples were collected,and the aqueous extract of Suanzaoren Decoction and the serum were analyzed using UHPLC-Q Exactive Orbitrap-MS technology to identify the prototype components and metabolites absorbed into the blood by comparing and analyzing with the LuMet-TCM database.RESULTS It showed that a total of 458 components were iden-tified in the aqueous extract of Suanzaoren Decoction,and 26 chemical components were identified in the blood,including 23 prototype components and 3 metabolites.CONCLUSION The prototype components absorbed into the blood discovered in this study may be the active ingredients of Suanzaoren Decoction,providing a reference for the research on the pharmacodynamic material basis of Suanza-oren Decoction.

Objective To evaluate the efficacy and safety of enteric-coated metformin hydrochloride capsules(Junlida?)in patients with T2DM and poor glycemic control under lifestyle interventions.Methods In this study,419 patients with T2DM were recruited from 15 research centers from July 2020 to March 2022,and randomly divided into observation(Obs)group(n=209)and control group(Con,n=210)using a multicenter,randomized,double-blind,non-inferiority trial design.Patients in the Obs group were treated with enteric-coated Metformin hydrochloride capsules(Junlida?),and patients in the Con group were treated with Metformin hydrochloride tablets(Glucophage?).The optimal effective dose of 2 g/d was achieved within 4 weeks,and the reasonable dose was maintained until the end of treatment.The treatment period was 24 weeks.HbA1c and its compliance rate,FPG,and body weight were compared between the two groups in full analysis set(FAS)and protocol set(PPS).Safety and adverse events(AE)were evaluated in safety set(SS).Results A total of 414 participants were randomized(207 cases in Obs group and 207 cases in Con group).414 cases in FAS population(207 cases in Obs group and 207 cases in Con group),and 328 cases in PPS population(164 cases in Obs group and 164 cases in Con group),and 414 cases in SS population(207 cases in Obs group and 207 cases in Con group).After treatment,HbA1c,FPG and body weight were lower in both groups(P<0.05)in FAS and PPS.HbA1c compliance rate was not significantly different between the two groups in FAS and PPS(P>0.05).The results of non-inferiority test showed that the lower limit was>-0.4%in both FAS(-0.154,95%CI-0.384～0.069)and PPS(-0.139,95%CI-0.390～0.112),and the Obs group reached non-inferiority end point.The achievement rate,compliance rate,safety index and incidence of AE were not significantly different between the two groups(P>0.05).Conclusions Junlida? demonstrated non-inferiority to Glucophage? in glycemic control and can be safely and effectively used in patients with diabetes.

Recent studies have revealed a significant association between Porphyromonas gingivalis(P.gingivalis)infection and poor prognosis in esophageal squamous cell carcinoma(ESCC).Although cer-tain circular RNAs(circRNA)have been shown to suppress ESCC tumorigenesis and progression,their regulatory mechanisms in P.gingivalis infection-associated ESCC remain elusive.In this study,RT-qPCR analysis demonstrated that P.gingivalis infection downregulated hsa_circ_0057552 expression in ESCC cells and tissues in a time-and dose-dependent manner.Actinomycin D assays further confirmed that P.gingivalis infection reduced the RNA stability of hsa_circ_0057552 in ESCC cells(P＜0.05).Functional assays in vitro and a subcutaneous tumor xenograft model in vivo revealed that hsa_circ_0057552 overexpression significantly inhibited ESCC cell proliferation,migration,invasion,and tumor growth(P＜0.05).Additionally,PCR array screening combined with RT-qPCR and Western blotting in-dicated that P.gingivalis infection markedly upregulated human antigen R(HuR)expression at both RNA and protein levels(P＜0.05).Mechanistic investigations demonstrated that HuR knockdown signifi-cantly increased hsa_circ_0057552 expression(P＜0.01),whereas hsa_circ_0057552 overexpression had no regulatory effect on HuR.Finally,si-HuR treatment reversed the inhibitory effect of P.gingivalis on hsa_circ_0057552 transcription.This study demonstrated that P.gingivalis may promote the progression of ESCC through a novel mechanism involving the regulation of HuR/hsa_circ_0057552,thereby identif-ying a novel therapeutic target and molecular marker for P.gingivalis-associated ESCC.

Anticoagulants are widely used in the prevention and treatment of thromboembolism.Existing anticoagulants share the common feature of antagonizing or blocking critical steps in the coagulation cascade,which also increases the risk of bleeding.Studies have indicated that factor Ⅺ inhibitors represent a potential therapeutic option for balancing thrombosis and bleeding risks.In recent years,various factor Ⅺ inhibitors,including antisense oligonucleotides(ASOs),monoclonal antibodies,synthetic small molecules,natural peptides,and aptamers,have been extensively researched as potentially exploitable anticoagu-lants.Research findings also suggest that factor Ⅺ inhibitors can reduce bleeding risks while ensuring anticoagulant efficacy,ex-hibiting potential for thrombosis prevention and treatment in patient populations such as those with end-stage renal disease,non-cardioembolic ischemic stroke,and acute coronary syndrome.This article reviewed the mechanisms of action,drug classes,pharma-cological characteristics,and clinical research progress of factor Ⅺ inhibitors,aiming to provide insights into the development of new anticoagulants and clinical anticoagulant therapies.

Objective To compare and analyze the application effects of ciprofol+remifentanil and remazolam+remifentanil in painless gastrointestinal gastroscopy in elderly overweight patients.Methods The subjects of this study,122 elderly overweight patients for painless gastrointestinal endoscopy from October 2023 to October 2024,were randomly divided into H group and R group,each with 61 cases.At the same time,122 elderly patients with normal body weight who planned to undergo painless gastrointestinal endoscopy during the same period were randomly divided into H1 group and R1 group,61 cases in each group.All subjects received a slow intravenous injection of remifentanil at a dose of 0.5 μg/kg,30 s later Group H and H1 group were administered with a slow intravenous injection of ciprofol at a dose of 0.4 mg/kg,while Group R and R1 group were given a slow intravenous injection of remazolam at a dose of 0.2 mg/kg.Anesthesia effect and perioperative indicators(examination time,induction time,etc.),and the hemodynamic parameters[mean arterial pressure(MAP),heart rate(HR)and percutaneous arterial oxygen saturation(SpO2)]were compared of the four groups immediately after the establishment of electrocardiogram monitoring(T0),upon completion of anesthesia induction(T1),when gastroscopy passed through the throat(T2),when enteroscopy passed through the hepatic flexure(T3),and immediately after completion of surgery(T4),as well as adverse reactions were compared of the four groups.Results Excellent anesthesia rate:group H and H1 group were higher than group R(96.72%,98.36%vs.86.89%,P<0.05).Induction time:no difference was found of the four groups(P>0.05).Examination time:group H and group R were significantly longer than that in group H1 and group R1(P<0.05),but there was no significant difference between group H and group R,and between group H1 and group R1(P>0.05).The time of awakening and moving out of postanesthesia care unit(PACU):group H,group R,group H1 and group R1 gradually decreased,and the differences between each two groups were statistically significant(P<0.05).There were statistically significant differences in MAP and HR of the four groups,time and interaction effects(P<0.05).The difference of SpO2 of the four groups was statistically significant(P<0.05),and the difference of time and interaction effect was not statistically significant(P>0.05).Incidence of injection pain:group H and group H1 were lower than group R and group R1(P<0.05).Incidence of other adverse reactions:no significant difference of four groups(P>0.05).Conclusion During painless gastrointestinal endoscopy of elderly overweight patients the application of ciprofol+remifentanil can achieve better anesthetic effect and lower incidence of injection pain as compared with remazolam+remifentanil.The anesthetic effect of the two anesthesia regimens is similar in elderly normal weight patients,but the elderly normal weight patients have a faster recovery from anesthesia than the elderly overweight patients.

This article summarizes Professor Huang Guicheng's clinical experience in the syndrome differentiation and treatment of lumbar spinal stenosis using the theory of"diseases of tendons,bones and collaterals".It is believed that lumbar spinal stenosis be-longs to the syndrome of deficiency in the root and excess in the superficiality,and is closely related to the three zang organs of the liv-er,spleen and kidney.Deficiency of the liver and kidney leading to a lack of the source of qi and blood,insufficiency of the spleen and stomach giving rise to phlegm and blood stasis,and the invasion of wind,cold and dampness pathogens cause the disease.The key to the pathogenesis lies in the obstruction of the collaterals.Taking the principles of"nourishing the collaterals and strengthening the healthy qi,dredging the collaterals and expelling the pathogens"as the therapeutic principles,Professor Huang is proficient in using insect drugs.The medicinal power can directly reach the collaterals,so that the collaterals can be unobstructed and the qi and blood can flow smoothly,achieving the therapeutic effect of expelling the pathogens,unblocking the collaterals and restoring the healthy qi.

Background and Aims:Unplanned reoperation is a critical indicator for evaluating the quality of surgical treatment and prognosis in patients with gastrointestinal perforation.Identifying its underlying causes,recognizing relevant risk factors,and developing effective preventive strategies are essential for optimizing treatment outcomes and improving patient prognosis.This study aimed to investigate the causes and risk factors of unplanned reoperation following surgery for gastrointestinal perforation,in order to provide clinical guidance for targeted interventions.Methods:The clinical data of 303 patients who underwent surgery for gastrointestinal perforation at the Department of General Surgery,Shijiazhuang People's Hospital,from January 2020 to July 2023,were retrospectively analyzed.Among them,218 were males and 85 were females,with a mean age of(61.05±17.95)years.Seventeen patients experienced unplanned reoperations after operation,while 286 did not.Univariate analysis and multivariate Logistic regression were performed to identify the risk factors associated with unplanned reoperation.A predictive model was developed and its performance was assessed using the receiver operating characteristic(ROC)curve.Results:Among the 17 patients who underwent unplanned reoperation,14 were males and 3 were females,with a mean age of(65.76±15.11)years.The primary causes of reoperation included postoperative fistula(7 cases),postoperative bleeding(4 cases),surgical site infection(2 cases),wound dehiscence(2 cases),and stoma-related complications(2 cases).Univariate analysis indicated that gender,comorbidities,hypoproteinemia,history of abdominal surgery,ASA score,surgical grade,and disease duration were significantly associated with unplanned reoperation(all P<0.05).Multivariate Logistic regression revealed that male gender(OR=99.62,95%CI=4.90-2 025.29,P<0.05),hypoproteinemia(OR=8.59,95%CI=1.81-40.91,P<0.05),history of abdominal surgery(OR=17.28,95%CI=3.42-87.32,P<0.05),higher ASA score(OR=11.89,95%CI=2.73-51.72,P<0.05),higher surgical grade(OR=17.15,95%CI=2.47-118.93,P<0.05),and longer disease duration(OR=1.04,95%CI=1.02-1.07,P<0.05)were independent risk factors.The ROC curve analysis showed that the predictive model constructed based on the above factors had a sensitivity of 0.90,a specificity of 0.88,and an area under the curve of 0.94(95%CI=0.88-0.99,P<0.001).Conclusion:The leading causes of unplanned reoperation after gastrointestinal perforation surgery are postoperative fistula and bleeding.Male gender,hypoproteinemia,and other high-risk factors significantly increase the likelihood of reoperation.Although most such surgeries are performed emergently,comprehensive preoperative assessment of relevant risk factors is crucial to reduce the incidence of unplanned reoperation,and improve patient outcomes.

Anticoagulants are widely used in the prevention and treatment of thromboembolism.Existing anticoagulants share the common feature of antagonizing or blocking critical steps in the coagulation cascade,which also increases the risk of bleeding.Studies have indicated that factor Ⅺ inhibitors represent a potential therapeutic option for balancing thrombosis and bleeding risks.In recent years,various factor Ⅺ inhibitors,including antisense oligonucleotides(ASOs),monoclonal antibodies,synthetic small molecules,natural peptides,and aptamers,have been extensively researched as potentially exploitable anticoagu-lants.Research findings also suggest that factor Ⅺ inhibitors can reduce bleeding risks while ensuring anticoagulant efficacy,ex-hibiting potential for thrombosis prevention and treatment in patient populations such as those with end-stage renal disease,non-cardioembolic ischemic stroke,and acute coronary syndrome.This article reviewed the mechanisms of action,drug classes,pharma-cological characteristics,and clinical research progress of factor Ⅺ inhibitors,aiming to provide insights into the development of new anticoagulants and clinical anticoagulant therapies.