Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

Objective:To assess the core competencies of internal medicine residents undergoing standardized residency training and to explore the effectiveness of core competency evaluation on mobile devices.Methods:The mobile formative evaluation module was developed based on the "Xueyiku" teaching management platform. From January to December 2023, clinical teachers were asked to evaluate 150 internal medicine residents based on the "Resident Core Competency Milestone Evaluation System in China Consortium of Elite Teaching Hospitals", and the results were analyzed using non-parametric tests.Results:Among the six core competencies of internal medicine residents, professionalism received the highest score, whereas teaching skill received a lower score (97.50 vs. 90.00; H=167.31, P<0.001). Second-year residents had significantly higher scores than first-year residents (93.00 vs. 90.00; P<0.001), but similar scores to third-year residents (93.00 vs. 93.00; P>0.05). In addition, there was no significant difference in score among residents with different medical education backgrounds ( P>0.05). Conclusions:More emphasis should be placed on improving the teaching skills of internal medicine residents, along with the implementation of tiered progressive training. The mobile core competency evaluation is an effective means for assessing the comprehensive skills of residents in a timely manner.

Objective:To examine the role of intestinal macrophages and the mechanism by which they produce reactive oxygen species (ROS) in abdominal pain induced by food antigens in mice with visceral hypersensitivity.Methods:Mouse models of visceral hypersensitivity were established by subjecting animals to acute cold restraint stress (ACRS) or acetic acid enema (AAE). Visceral sensitivity was evaluated using food antigen ovalbumin (OVA)-induced responses and rectal reflex measurements following ROS scavenging. The activity of intestinal macrophages was assessed using flow cytometry. In vitro enzyme immunoassays and in vivo imaging techniques were employed to quantify ROS levels. Furthermore, the influence of OVA on ROS levels following intestinal macrophage depletion was investigated. Cell culture experiments were conducted to investigate the effects of OVA on intestinal macrophage function and ROS production.Results:The two visceral hypersensitivity mouse models exhibited a significantly lower pain threshold compared to the control group. OVA-induced visceral hypersensitivity mice demonstrated enhanced visceral motor responses (VMRs), with an increase in abdominal ROS levels (ACRS vs. control: 62.00±7.68 vs. 19.80±2.39, P<0.001; AAE vs. control: 461.80±17.25 vs. 19.80±2.39, P<0.001). When ROS were cleared from the abdominal cavity of mice, VMRs were restored to normal levels (AAE vs. AAE+ROS: 83.50±8.72 vs. 71.66±2.67, P=0.010). In this mouse model, intestinal macrophages could be classified into CD45 Med and CD45 High subtypes based on the level of CD45 expression. In the AAE group, the expression of CD45 Med macrophages in the intestinal tract decreased (AAE vs. control: 0.121±0.026 vs. 0.194±0.021, P=0.007), whereas the expression of CD45 High macrophages increased (AAE vs. control: 0.249±0.087 vs. 0.018±0.003, P=0.027). Compared with the control group, the expression of CD11b in both types of macrophages increased significantly (CD45 Med vs. control: 39 547.00±4 422.59 vs. 4 055.67±506.05, P<0.05; CD45 High vs. control: 18 960.00±1 197.84 vs. 3 147.50±286.38, P=0.008), while the expression of F4/80 decreased (CD45 Med vs. control: 6 141.67±750.06 vs. 10 544.33±974.92, P=0.008; CD45 High vs. control: 1 291.50±119.50 vs. 4 007.50±327.39, P<0.001). These findings suggest that the activity of intestinal macrophages in visceral hypersensitivity mice is altered following OVA induction. By injecting different populations of macrophages into the peritoneal cavity of mice, it was found that compared to the AAE group, the injection of CD45 High macrophages significantly increased the VMR in mice (AAE vs. AAE CD45 High: 83.50±8.72 vs. 114.38±7.15, P<0.001), and aggravated the severity of diarrhea significantly. In vitro experiments revealed that food antigens could directly induce ROS production in macrophages. Compared with the control group, both the ACRS and AAE groups of mice exhibited significant diarrhea symptoms. In contrast, the severity of diarrhea in the Macrophages exhaust+ACRS and Macrophages exhaust+AAE groups was substantially reduced, with a significantly shortened recovery period. Additionally, compared with the AAE group, the degree of diarrhea in the AAE+ROSS group was alleviated. Conclusions:Food antigens may act on intestinal macrophages, inducing abdominal pain and diarrhea in visceral hypersensitive mice via the ROS pathway. CD45 High macrophages may play a pivotal role in this process.

Objective:To quantitatively evaluate the effects of left bundle branch block（LBBB）on left ventricular structure，function and myocardial perfusion using left ventricular pressure-strain loop and single photon emission computed tomography（SPECT），and to investigate the relationship between myocardial work，myocardial perfusion and pathological changes of left ventricular remodeling in left bundle branch block induced cardiomyopathy（LBBB-CM）.Methods:Fourteen male beagle dogs were selected，and the main trunk of the left bundle branch was ablated to create an LBBB dog model. Electrocardiogram（ECG），transesophageal echocardiography and arterial blood pressure data of LBBB dogs were collected before and 12 months after the ablation of left bundle branch trunk. Global and segmental myocardial work parameters were obtained by left ventricular pressure-strain loop. The differences of above parameters between baseline and 12 months after the ablation of left bundle branch were compared. SPECT was performed in LBBB dogs 12 months after the creation of LBBB. The hearts were harvested for anatomy observation and histopathological analysis in LBBB dogs and another 7 male beagle dogs（normal control group）matched by age and weight. The correlation between myocardial perfusion（percentage of regional tracer uptake）and myocardial work parameters，myocardial fibrosis in LBBB dogs were analyzed.Results:Compared with baseline，the left ventricular end-diastolic volume of 12 months after the ablation increased［（20.78 ± 5.32）ml vs（26.71 ± 7.94）ml， P = 0.003］，left ventricular ejection fraction decreased［（59.17 ± 5.67）% vs（47.69 ± 5.45）%， P<0.001］；left ventricular global/segmental longitudinal strain，global/segmental constructive work and global/segmental work efficiency decreased（all P<0.05），left ventricular global/segmental wasted work increased（all P<0.001）. Heterogenous perfusion defect was observed in LBBB dogs by SPECT，compared with lateral wall segments，the percentage of regional tracer uptake of septum was decreased（all P<0.05）. Gross anatomical and myocardial pathological changes were manifested as cardiomegaly，flaky or focal grayish thickening of endocardium，cardiomyocyte degeneration and fibrosis. Compared with normal control group，the collagen fiber volume fraction（CVF）in all segmental endocardium and partial segmental myocardium of LBBB dogs were significantly increased（all P<0.05）. Percentage of regional tracer uptake was positively correlated with segmental myocardial work（SMW）and segmental myocardial efficiency（SWE）（ r s = 0.49，0.31；both P<0.001），and negatively correlated with CVF and segmental wasted work（SWW）（ r s = -0.51，-0.49；both P<0.001）. Conclusions:Isolated LBBB is not benign，which can result in left ventricular remodeling，decreased cardiac constructive function，abnormal myocardial perfusion，endocardial fibrosis and myocardial fibrosis.The parameters of myocardial work assecsed by echocardiograpgy and myocardial perfusion，as non-invasive examination，can to some extent reflect the degree of left ventricular remodeling in LBBB-CM.

Background and purpose:Accurate preoperative differentiation between vagal nerve cervical schwannomas(SCCS)and sympathetic chain cervical schwannomas(SCCS)in the neck is crucial because of their different postoperative complication.This study aimed to construct and validate a Diagnosis Score and vascular displacement nomogram for the preoperative differentiation of VNCS from SCCS in the neck.Methods:This cross-sectional study retrospectively analyzed patients with pathologically confirmed VNCS and SCCS at Fudan University Shanghai Cancer Center from January 2017 to April 2022.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(approval number:1612167-18).Inclusion criteria:① histopathological diagnosis of VNCS or SCCS through biopsy or surgical resection;② patients with complete clinic data;③availability of preoperative contrast-enhanced computed tomography(CT)or magnetic resonance imaging(MRI)examinations.Patients were excluded for:① contrast agent contraindications;② poor image quality;③ severe artifacts;④ non-standard scanning protocols.The cohort was randomly divided into training and validation sets in a 7∶3 ratio.Two radiologists(one resident and one attending physician)independently evaluated tumor characteristics(location,size and vascular displacement patterns)on preoperative imaging.Independent predictors were selected using LASSO regression analysis to construct a diagnostic scoring system and nomogram,with model performance evaluated by the receiver operating characteristic(ROC)curve.Results:A total of 110 patients were enrolled,with 77 cases allocated to the training set and 33 cases to the validation set.The age range was 24-78 years,and the mean age was(51.22±12.36)years.There were no statistically significant differences in baseline characteristics including age,gender,tumor location and size between the two patient groups(P＞0.05).ICA/ECA splaying was significantly associated with SCCS(P＜0.001),while the ICA/IJV splaying was significantly associated with VNCS(P＜0.001).Lateral and posterior ICA displacement were significantly associated with SCCS(P＜0.001),and medial and anterior ICA displacement were significantly associated with VNCS(P＜0.001).Five features including tumor size,ICA displacement direction,IJV displacement direction,ICA/ECA splaying and ICA/IJV splaying were used to establish the Diagnosis Score and nomogram.The nomogram combined imaging features showed favorable preference value for differentiating VNCS from SCCS,with area under curve(AUC)values of 0.953(95%CI:0.912-0.994)and 0.939(95%CI:0.885-0.993)for the training and validation cohorts,respectively.Conclusion:The Diagnosis Score and vascular displacement nomogram showed favorable predictive efficacy for differentiating VNCS from SCCS in the neck,and might be useful for clinical decision-making.

Background and purpose:Accurate preoperative differentiation between vagal nerve cervical schwannomas(SCCS)and sympathetic chain cervical schwannomas(SCCS)in the neck is crucial because of their different postoperative complication.This study aimed to construct and validate a Diagnosis Score and vascular displacement nomogram for the preoperative differentiation of VNCS from SCCS in the neck.Methods:This cross-sectional study retrospectively analyzed patients with pathologically confirmed VNCS and SCCS at Fudan University Shanghai Cancer Center from January 2017 to April 2022.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(approval number:1612167-18).Inclusion criteria:① histopathological diagnosis of VNCS or SCCS through biopsy or surgical resection;② patients with complete clinic data;③availability of preoperative contrast-enhanced computed tomography(CT)or magnetic resonance imaging(MRI)examinations.Patients were excluded for:① contrast agent contraindications;② poor image quality;③ severe artifacts;④ non-standard scanning protocols.The cohort was randomly divided into training and validation sets in a 7∶3 ratio.Two radiologists(one resident and one attending physician)independently evaluated tumor characteristics(location,size and vascular displacement patterns)on preoperative imaging.Independent predictors were selected using LASSO regression analysis to construct a diagnostic scoring system and nomogram,with model performance evaluated by the receiver operating characteristic(ROC)curve.Results:A total of 110 patients were enrolled,with 77 cases allocated to the training set and 33 cases to the validation set.The age range was 24-78 years,and the mean age was(51.22±12.36)years.There were no statistically significant differences in baseline characteristics including age,gender,tumor location and size between the two patient groups(P＞0.05).ICA/ECA splaying was significantly associated with SCCS(P＜0.001),while the ICA/IJV splaying was significantly associated with VNCS(P＜0.001).Lateral and posterior ICA displacement were significantly associated with SCCS(P＜0.001),and medial and anterior ICA displacement were significantly associated with VNCS(P＜0.001).Five features including tumor size,ICA displacement direction,IJV displacement direction,ICA/ECA splaying and ICA/IJV splaying were used to establish the Diagnosis Score and nomogram.The nomogram combined imaging features showed favorable preference value for differentiating VNCS from SCCS,with area under curve(AUC)values of 0.953(95%CI:0.912-0.994)and 0.939(95%CI:0.885-0.993)for the training and validation cohorts,respectively.Conclusion:The Diagnosis Score and vascular displacement nomogram showed favorable predictive efficacy for differentiating VNCS from SCCS in the neck,and might be useful for clinical decision-making.

Objective:To assess the core competencies of internal medicine residents undergoing standardized residency training and to explore the effectiveness of core competency evaluation on mobile devices.Methods:The mobile formative evaluation module was developed based on the "Xueyiku" teaching management platform. From January to December 2023, clinical teachers were asked to evaluate 150 internal medicine residents based on the "Resident Core Competency Milestone Evaluation System in China Consortium of Elite Teaching Hospitals", and the results were analyzed using non-parametric tests.Results:Among the six core competencies of internal medicine residents, professionalism received the highest score, whereas teaching skill received a lower score (97.50 vs. 90.00; H=167.31, P<0.001). Second-year residents had significantly higher scores than first-year residents (93.00 vs. 90.00; P<0.001), but similar scores to third-year residents (93.00 vs. 93.00; P>0.05). In addition, there was no significant difference in score among residents with different medical education backgrounds ( P>0.05). Conclusions:More emphasis should be placed on improving the teaching skills of internal medicine residents, along with the implementation of tiered progressive training. The mobile core competency evaluation is an effective means for assessing the comprehensive skills of residents in a timely manner.

Objective:To examine the role of intestinal macrophages and the mechanism by which they produce reactive oxygen species (ROS) in abdominal pain induced by food antigens in mice with visceral hypersensitivity.Methods:Mouse models of visceral hypersensitivity were established by subjecting animals to acute cold restraint stress (ACRS) or acetic acid enema (AAE). Visceral sensitivity was evaluated using food antigen ovalbumin (OVA)-induced responses and rectal reflex measurements following ROS scavenging. The activity of intestinal macrophages was assessed using flow cytometry. In vitro enzyme immunoassays and in vivo imaging techniques were employed to quantify ROS levels. Furthermore, the influence of OVA on ROS levels following intestinal macrophage depletion was investigated. Cell culture experiments were conducted to investigate the effects of OVA on intestinal macrophage function and ROS production.Results:The two visceral hypersensitivity mouse models exhibited a significantly lower pain threshold compared to the control group. OVA-induced visceral hypersensitivity mice demonstrated enhanced visceral motor responses (VMRs), with an increase in abdominal ROS levels (ACRS vs. control: 62.00±7.68 vs. 19.80±2.39, P<0.001; AAE vs. control: 461.80±17.25 vs. 19.80±2.39, P<0.001). When ROS were cleared from the abdominal cavity of mice, VMRs were restored to normal levels (AAE vs. AAE+ROS: 83.50±8.72 vs. 71.66±2.67, P=0.010). In this mouse model, intestinal macrophages could be classified into CD45 Med and CD45 High subtypes based on the level of CD45 expression. In the AAE group, the expression of CD45 Med macrophages in the intestinal tract decreased (AAE vs. control: 0.121±0.026 vs. 0.194±0.021, P=0.007), whereas the expression of CD45 High macrophages increased (AAE vs. control: 0.249±0.087 vs. 0.018±0.003, P=0.027). Compared with the control group, the expression of CD11b in both types of macrophages increased significantly (CD45 Med vs. control: 39 547.00±4 422.59 vs. 4 055.67±506.05, P<0.05; CD45 High vs. control: 18 960.00±1 197.84 vs. 3 147.50±286.38, P=0.008), while the expression of F4/80 decreased (CD45 Med vs. control: 6 141.67±750.06 vs. 10 544.33±974.92, P=0.008; CD45 High vs. control: 1 291.50±119.50 vs. 4 007.50±327.39, P<0.001). These findings suggest that the activity of intestinal macrophages in visceral hypersensitivity mice is altered following OVA induction. By injecting different populations of macrophages into the peritoneal cavity of mice, it was found that compared to the AAE group, the injection of CD45 High macrophages significantly increased the VMR in mice (AAE vs. AAE CD45 High: 83.50±8.72 vs. 114.38±7.15, P<0.001), and aggravated the severity of diarrhea significantly. In vitro experiments revealed that food antigens could directly induce ROS production in macrophages. Compared with the control group, both the ACRS and AAE groups of mice exhibited significant diarrhea symptoms. In contrast, the severity of diarrhea in the Macrophages exhaust+ACRS and Macrophages exhaust+AAE groups was substantially reduced, with a significantly shortened recovery period. Additionally, compared with the AAE group, the degree of diarrhea in the AAE+ROSS group was alleviated. Conclusions:Food antigens may act on intestinal macrophages, inducing abdominal pain and diarrhea in visceral hypersensitive mice via the ROS pathway. CD45 High macrophages may play a pivotal role in this process.

Objective:To quantitatively evaluate the effects of left bundle branch block（LBBB）on left ventricular structure，function and myocardial perfusion using left ventricular pressure-strain loop and single photon emission computed tomography（SPECT），and to investigate the relationship between myocardial work，myocardial perfusion and pathological changes of left ventricular remodeling in left bundle branch block induced cardiomyopathy（LBBB-CM）.Methods:Fourteen male beagle dogs were selected，and the main trunk of the left bundle branch was ablated to create an LBBB dog model. Electrocardiogram（ECG），transesophageal echocardiography and arterial blood pressure data of LBBB dogs were collected before and 12 months after the ablation of left bundle branch trunk. Global and segmental myocardial work parameters were obtained by left ventricular pressure-strain loop. The differences of above parameters between baseline and 12 months after the ablation of left bundle branch were compared. SPECT was performed in LBBB dogs 12 months after the creation of LBBB. The hearts were harvested for anatomy observation and histopathological analysis in LBBB dogs and another 7 male beagle dogs（normal control group）matched by age and weight. The correlation between myocardial perfusion（percentage of regional tracer uptake）and myocardial work parameters，myocardial fibrosis in LBBB dogs were analyzed.Results:Compared with baseline，the left ventricular end-diastolic volume of 12 months after the ablation increased［（20.78 ± 5.32）ml vs（26.71 ± 7.94）ml， P = 0.003］，left ventricular ejection fraction decreased［（59.17 ± 5.67）% vs（47.69 ± 5.45）%， P<0.001］；left ventricular global/segmental longitudinal strain，global/segmental constructive work and global/segmental work efficiency decreased（all P<0.05），left ventricular global/segmental wasted work increased（all P<0.001）. Heterogenous perfusion defect was observed in LBBB dogs by SPECT，compared with lateral wall segments，the percentage of regional tracer uptake of septum was decreased（all P<0.05）. Gross anatomical and myocardial pathological changes were manifested as cardiomegaly，flaky or focal grayish thickening of endocardium，cardiomyocyte degeneration and fibrosis. Compared with normal control group，the collagen fiber volume fraction（CVF）in all segmental endocardium and partial segmental myocardium of LBBB dogs were significantly increased（all P<0.05）. Percentage of regional tracer uptake was positively correlated with segmental myocardial work（SMW）and segmental myocardial efficiency（SWE）（ r s = 0.49，0.31；both P<0.001），and negatively correlated with CVF and segmental wasted work（SWW）（ r s = -0.51，-0.49；both P<0.001）. Conclusions:Isolated LBBB is not benign，which can result in left ventricular remodeling，decreased cardiac constructive function，abnormal myocardial perfusion，endocardial fibrosis and myocardial fibrosis.The parameters of myocardial work assecsed by echocardiograpgy and myocardial perfusion，as non-invasive examination，can to some extent reflect the degree of left ventricular remodeling in LBBB-CM.

Objective To evaluate the predictive value of CT-enhanced imaging-based radiomics nomogram for the status of microsatel-lite instability(MSI)in colon cancer.Methods A retrospective analysis was conducted on 129 postoperative colon cancer patients with confirmed MSI status.They were randomly divided into a training group(n=90)and a validation group(n=39)at a ratio of 7:3.Radiomics features were extracted from preoperative CT-enhanced images of the patients.The predictive performance of various machine learning algorithms was evaluated using the area under the curve(AUC).A nomogram model was developed by incorporating clinical independent risk factors,and the model's overall performance was assessed using decision curve analysis(DCA).Results Age and lesion site were identified as prominent independent risk factors and utilized in the construction of a clinical model.The light gradient boosting machine(LightGBM)algorithm was chosen for building a radiomics model.As a joint model,the AUC of the nomogram model of 0.917 in the training group and 0.822 in the validation group.The DCA confirmed the substantial clinical applicability of the nomogram model.Conclusion The CT-enhanced imaging-based radiomics nomogram offers a pioneering and individualized predic-tive approach for determining the MSI status in colon cancer.