Endodontic microsurgery (EMS) is an oral surgical procedure that utilizes the magnification and illumination provided by a microscope. Fine instruments are used to remove periapical diseased tissues, resect the root apex, and tightly seal the root canal system, aiming to promote the healing of periapical tissues and retain the affected tooth whenever possible. Precise localization and resection of the root apex have always been challenging in EMS. The application of digital technology in EMS can address many issues in traditional endodontic microsurgery. Digital technology offers advantages such as optimizing surgical planning, providing precise positioning guidance, and enhancing operational accuracy. Currently, the commonly used digital technologies in EMS include static and dynamic navigation technologies and oral surgical robots. Static navigation technology enhances surgical predictability through precise preoperative planning and guided fabrication, yet is constrained by its inability to adjust during surgery. Dynamic navigation technology excels in real-time tracking and intraoperative flexibility but demands high hand-eye coordination from surgeons and may be hindered by bulky handheld devices. Oral surgical robots reduce hand tremors and human error in surgery with their high precision, stability, and ability to adjust in real time, but their clinical applicability is limited and their cost is high. In clinical practice, tailored combinations of these technologies can be applied based on case complexity. For simple cases with well-defined anatomy, static navigation alone may suffice. For complex anatomical cases, static navigation can provide initial planning, supplemented by dynamic navigation for real-time guidance or robotic systems for high-precision execution. This paper discusses the workflow, clinical application status and advantages and limitations of these three digital technologies in EMS. The continuous development of digital technology is expected to simplify the operation process, improve the navigation accuracy, and reduce the operation cost. It is believed that with continuous improvement and optimization, these technologies will effectively break through the current bottleneck of the cost of equipment, operation complexity, and accuracy enhancement. These technologies are also expected to further expand the application boundaries, providing more minimally invasive, precise, and time-saving personalized treatment solutions for endodontic diseases.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

This study aimed to elucidate the mechanism of action of metformin (MET) in inhibiting the malignant progression of hepatocellular carcinoma (HCC) by regulating the degradation of aldo-keto reductase family 1 member C3 (AKR1C3). The correlation between the sensitivity of different hepatocellular carcinoma cell lines to MET and their basal expression levels of AKR1C3 was firstly evaluated. MET was found to significantly reduce the level and accelerate the degradation rate of AKR1C3 protein by Western blot. The interaction between MET and AKR1C3 protein was confirmed by cellular thermal shift assay (CETSA). Proteasome inhibitor MG132 and the lysosomal inhibitor chloroquine (CQ) were used to screen the degradation pathway, and confirm, in combination with the HBSS starvation-induced autophagy model, that MET mediated the degradation of AKR1C3 through the autophagy lysosome pathway. Ubiquitylation assay showed that MET specifically enhanced the K63-linked polyubiquitylation modification of AKR1C3. Sequestosome 1 (SQSTM1/p62) knockdown, immunoprecipitation, and immunofluorescence co-localization analyses confirmed that the autophagy receptor p62 plays a key role in mediating MET-induced degradation of AKR1C3. The adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) inhibitor compound C was used to demonstrate that the regulatory effect of MET on AKR1C3 is independent of the classical AMPK signaling pathway. The experimental results showed that metformin promoted the ubiquitination modification of AKR1C3 by targeting AKR1C3, enhanced the binding of AKR1C3 to autophagy receptor p62, then degraded the AKR1C3 protein through selective autophagy-like pathway, and ultimately inhibited the malignant phenotypes of hepatocellular carcinoma cells, which is a regulatory mechanism free of the classical AMPK activation pathway of metformin.

Objective:To explore the effectiveness of a multimodal TeamSTEPPS course based on clinical cases in training surgical teams led by anesthesiologists, improve team cooperation in crisis management, and enhance clinical safety.Methods:The Department of Anesthesiology at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, combined the TeamSTEPPS course with problem-based learning. Based on eight clinical cases, simulation-based training was conducted for interdisciplinary personnel, including anesthesiologists, surgeons, and operating room nurses. Pre- and post-training evaluations were conducted for 80 participants on theoretical knowledge and teamwork. Statistical analysis was performed using SPSS 27.0 software. The differences in scale scores before and after training were tested for normality. If normally distributed, results were expressed as mean ± standard deviation and analyzed using paired t-tests. Participant demographic data were represented using percentages. Results:The theoretical assessment scores after training were significantly higher than those before training [(76.45±8.34) vs. (60.21±5.90), t=13.55, P<0.001]. TeamSTEPPS Teamwork Perception Questionnaire and TeamSTEPPS Teamwork Attitudes Questionnaire scores were significantly higher after training than before training [(156.08±15.20) vs. (149.32±15.58) and (134.59±10.71) vs. (128.47±10.89)], with statistically significant differences ( P<0.001). Conclusions:The TeamSTEPPS management course in combination with problem-based learning can enhance the clinical theoretical knowledge of anesthesiologists and improve their team awareness and collaboration, thus improving their clinical competence in managing crisis events.

Objective:To investigate and analyze case reporting ethical review and patient informed consent reports published in the comprehensive journals of clinical medicine in China in 2022.Methods:According to the data from the 2022 Edition of the Chinese Science and Technology Journal of the Citation Reports(Extended Version),the case reports published in comprehensive journals of clinical medicine in 2022 were selected as the research objects.The information on ethics and patient informed consent was extracted from the case reports that met the selection criteria,and Microsoft Excel 2021 and SPSS 21.0 were used to sort out and analyze the data.Results:A total of 587 case reporting articles were published in the 42 included journals in 2022,of which 36(6.13%)reported on science and technology ethics and/or informed consent.Case reports reporting on science and technology ethics and/or informed consent mostly came from the key magazine of China technology(88.89%Vs.65.88%),and the proportion of manuscripts involving science and technology ethics on the official website of the journal was relatively high(86.11%Vs.63.88%),and the difference was statistically significant(P＜0.01).Conclusion:The proportion of case reports of science and technology ethics and/or informed consent in journals of comprehensive discipline classification of clinical medicine was relatively low.Currently,most international journals are required to obtain the informed consent of patients or legal guardians before publishing case reports.Compared with this,there are still certain gaps in China,which need to be paid great attention to.

Objective:To explore the effectiveness of a multimodal TeamSTEPPS course based on clinical cases in training surgical teams led by anesthesiologists, improve team cooperation in crisis management, and enhance clinical safety.Methods:The Department of Anesthesiology at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, combined the TeamSTEPPS course with problem-based learning. Based on eight clinical cases, simulation-based training was conducted for interdisciplinary personnel, including anesthesiologists, surgeons, and operating room nurses. Pre- and post-training evaluations were conducted for 80 participants on theoretical knowledge and teamwork. Statistical analysis was performed using SPSS 27.0 software. The differences in scale scores before and after training were tested for normality. If normally distributed, results were expressed as mean ± standard deviation and analyzed using paired t-tests. Participant demographic data were represented using percentages. Results:The theoretical assessment scores after training were significantly higher than those before training [(76.45±8.34) vs. (60.21±5.90), t=13.55, P<0.001]. TeamSTEPPS Teamwork Perception Questionnaire and TeamSTEPPS Teamwork Attitudes Questionnaire scores were significantly higher after training than before training [(156.08±15.20) vs. (149.32±15.58) and (134.59±10.71) vs. (128.47±10.89)], with statistically significant differences ( P<0.001). Conclusions:The TeamSTEPPS management course in combination with problem-based learning can enhance the clinical theoretical knowledge of anesthesiologists and improve their team awareness and collaboration, thus improving their clinical competence in managing crisis events.

Changes in cardiac structure and function such as myocardial aging,valve alterations,alterations in the cardiac conduction system and vascular aging are crucial for studying therapeutic methods for age-related cardiovascular diseases.Histone methylation modification is involved in the regulation of gene expression and closely related to the occurrence and development of age-related car-diovascular diseases.This paper provided a comprehensive review on the role of histone methylation modification in cardiac structural and functional changes,providing new theoretical basis for age-relat-ed cardiovascular diseases.

Changes in cardiac structure and function such as myocardial aging,valve alterations,alterations in the cardiac conduction system and vascular aging are crucial for studying therapeutic methods for age-related cardiovascular diseases.Histone methylation modification is involved in the regulation of gene expression and closely related to the occurrence and development of age-related car-diovascular diseases.This paper provided a comprehensive review on the role of histone methylation modification in cardiac structural and functional changes,providing new theoretical basis for age-relat-ed cardiovascular diseases.

Objective To investigate the pathology, epidemiology of severe pneumonia in Xicheng District of Beijing. Methods From 2014 to 2020, in 3 sentinel hospitals, collected and detected the respiratory tract specimens of the severe pneumonia patients. Multiple pathogens including Stenotrophomonas maltophilia, Streptococcus pyogenes, Staphylococcus aureus, Klebsiella Pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycobacterium tuberculosis, Acinetobacter baumannii, Moraxella catarrhalis, Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Pneumocystis,Parainfluenza virus, Bocavirus, Rhinovirus, Coronavirus, Influenza, Human metapneumovirus, Adenovirus, Respiratory syncytial virus, Enterovirus, Mycoplasma pneumoniae, Chlamydia pneumoniae were detected with PT-PCR. Analyze epidemic characteristics of the cases. Results Of the 1 247 respiratory samples cultured during the period from 2014 to 2020, 560(44.91%) are positive. The positive rates of virus(29.91%) is higher than Bacteria(20.21%). The top five pathogens were Acinetobacter baumannii(9.22%), Pseudomonas aeruginosa(8.26%), Stenotrophomonas maltophilia(7.78%), Klebsiella Pneumoniae（6.74%） and Parainfluenza virus（6.58%）. Conclusion There was a variety of pathogen in the severe pneumonia patients. Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella Pneumoniae and Parainfluenza virus were the main pathogens of respiratory infections in Xicheng district of Beijing. It is necessary to strengthen the surveillance of the disease.

Objective To determine the effect of trunk motion control on knee biomechanics during single-leg landing. Methods Twenty male healthy basketball players were recruited. The kinematics, kinetics parameters and surface electromyogram (EMG) of knee joints under trunk motion control during single-leg landing were studied by using Vicon motion Analysis system, Kistler force platform and Noraxon surface EMG system. Results Compared with natural landing, there were significant differences in flexion angle at initial contact moment, peak flexion angle and peak flexion moment during deeply inspiratory landing and landing with a stick, and a significantly larger flexion angle at initial contact moment, a larger peak flexion angle and smaller peak flexion moment were also found. Compared with natural landing, there was no statistical difference in peak valgus angle and peak valgus moment, as well as EMG activity of hamstrings, quadriceps muscles of the knee during deeply inspiratory landing and landing with a stick. Conclusions Deeply inspiratory landing or landing with a stick reduce the risk of anterior cruciate ligament (ACL) injury, and the results provide the theoretical basis for prevention of ACL injuries in basketball players during landing.